WSR 12-01-081



(Medicaid Program)

[ Filed December 19, 2011, 4:39 p.m. ]

Subject of Possible Rule Making: Chapter 182-530 WAC, Prescription drugs (outpatient) and possibly other related chapters and sections as necessary.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 41.05.021; Social Security Act, Section 1927.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: To avoid elimination of the pharmacy benefit for medicaid clients in response to budget shortfalls, the state intends to submit a state plan amendment (SPA) to implement a formulary in accordance with the provisions of Section 1927 of the Social Security Act, and establish a process through which medicaid prescribers may request authorization for their patient to receive a nonformulary medication. The health care authority (HCA) anticipates the resulting outpatient drug formulary will be effective July 1, 2012, and will apply to all medicaid and medical assistance clients. New rules on this subject are necessary in order [to] establish the process through which the formulary will be developed and managed, and the process through which exceptions will be made.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: United States Department of Health and Human Services' Centers for Medicare and Medicaid Services - HCA will be submitting an amendment to Washington state's medicaid state plan.

Process for Developing New Rule: HCA welcomes the public to take part in developing the rules. Anyone interested should contact the staff person identified below. At a later date, HCA will file a notice of proposed rule-making (CR-102) with the office of the code reviser. A copy of the proposal will be sent to everyone on the mailing list and to anyone who requests a copy.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Kevin Sullivan, P.O. Box 45504, Olympia, WA 98504-5504, phone (360) 725-1344, fax (360) 586-9727, TTY 1-800-848-5429, e-mail

December 19, 2011

Kevin M. Sullivan

Rules Coordinator

Washington State Code Reviser's Office