Description: On March 21, 2023, the health care authority (HCA) filed notice under WSR 23-07-114 of the intent to submit a SPA to address the level of the professional dispensing fees paid to pharmacies for providing services to medicaid clients in the fee-for-service program. In addition to the professional dispensing fees, HCA pays a drug ingredient cost. That notice stated that the annual aggregate expenditures/reimbursement/payments in the fee-for-service pharmacy program was expected to increase, but HCA did not yet have a formal estimate of the anticipated amount of the potential increase and that HCA did not anticipate changes to the ingredient cost methodology.

On April 25, 2023, HCA filed an amended notice under WSR 23-20-015, presenting the following tentative amounts for the fee-for-service pharmacy program for professional dispensing fees:

Fee Structure	High Volume	Middle Volume	Low Volume	Unit Dose
Increase in fees	$9.80 (Increase of $5.56)	$11.91 (Increase of $7.35)	$14.30 (Increase of $9.05)	$14.30 (Increase of $9.05 )

At this time, HCA anticipates the following changes in the fee-for-service pharmacy program for professional dispensing fees, which are expected to increase the annual aggregate expenditures/reimbursement/payments by an estimated $60,562,287.00 annually, combined state and federal funds. Please note the following amounts are tentative:

Fee Structure	High Volume	Middle Volume	Low Volume	Unit Dose
Increase in fees	70,000 or more claims per year $9.80	Between 30,000 - 69,999 claims per year $11.91	Less than 30,000 claims per year $14.30	$14.30

This SPA is under development. To request a copy when it becomes available or to submit comments, you may contact Amy Irwin at amy.irwin@hca.wa.gov (please note that all comments are subject to public review and disclosure, as are the names of those who comment).