PERMANENT RULES
Date of Adoption: December 15, 2000.
Purpose: The rule will create a discount prescription drug program which will allow individuals fifty-five years or older, without prescription drug coverage to access discounted prescription drugs.
Statutory Authority for Adoption: RCW 43.70.040 (1) and (5), 43.70.020(5).
Other Authority: RCW 43.70.130, 43.70.060.
Adopted under notice filed as WSR 00-22-121 on November 1, 2000.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 3, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 3, Amended 0, Repealed 0. Effective Date of Rule: Thirty-one days after filing.
December 15, 2000
M. C. Selecky
Secretary
OTS-4485.1
THE AWARDS PROGRAM
(2) Goals. The program's goals are:
(a) To promote public health by making prescription drugs more affordable for AWARDS members; and
(b) To assess the program's effectiveness in making prescription drugs more affordable for AWARDS members.
(3) Definitions.
(a) "AWARDS (A Washington Alliance to Reduce Prescription Drug Spending)" is a purchasing alliance sponsored by the state of Washington. AWARDS members are charged a discounted rate for prescription drugs.
(b) An "individual membership" is available for a Washington resident fifty-five years of age or older who has no prescription drug coverage and pays an annual individual membership fee to participate in the AWARDS program.
(c) A "family membership" is available for two or more Washington residents fifty-five years of age or older who have no prescription drug coverage, who are living in the same household, and who, on behalf of the family, pay an annual family membership fee to participate in the AWARDS program.
(d) "Pharmacy benefits manager" means the entity responsible for pharmacy benefits management services, member enrollment, the AWARDS pharmacy network, provision of assessment data, and administrative duties through a contract with the state of Washington.
(e) "Participating pharmacy" means a pharmacy that agrees to serve AWARDS members as part of a pharmacy network on terms set by the pharmacy benefits manager.
(f) "AWARDS discount price" means the reduced cost for prescription drugs set by contract between the state and the pharmacy benefits manager. Participating pharmacies accept the AWARDS discount price as full payment when AWARDS members buy prescription drugs.
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(1) The AWARDS program operates at no cost to the state. AWARDS members pay the AWARDS discount price when buying prescription drugs from a participating pharmacy and show a valid membership card. AWARDS members can also buy prescriptions by mail through the pharmacy benefits manager.
(2) AWARDS is administered in cooperation with the Washington state health care authority through a contract with a pharmacy benefits manager.
(3) Any Washington resident who is fifty-five years of age or older and has no prescription drug coverage is eligible to apply for an individual or family membership in the AWARDS program.
(4) Applicants for AWARDS membership must send an AWARDS membership application to the pharmacy benefits manager. Applicants must certify that they are fifty-five years of age or older and have no prescription drug coverage. Applicants must also pay for an individual or family membership. The pharmacy benefits manager will send a membership card to approved applicants. When presenting a membership card at any participating pharmacy, AWARDS members will be charged the AWARDS discount price for prescription drugs. AWARDS members can also order prescription drugs by mail through the pharmacy benefits manager.
(5) An AWARDS membership may be canceled when a member:
(a) Is not eligible;
(b) Fails to pay the membership fee when due;
(c) Violates the terms and conditions of membership;
(d) Misuses or permits unauthorized use of the membership card; or
(e) Engages in misconduct in connection with the AWARDS program.
If a membership is canceled due to (c) through (e) of this subsection, the membership fee may be forfeited and the member may be subject to other penalties under applicable laws. The AWARDS pharmacy benefits manager is responsible for enrollment decisions, for maintaining records, and for administering all member services. Any disputes arising between an applicant for AWARDS membership or an AWARDS member and the pharmacy benefits manager is a private contractual dispute. Disputes are resolved according to the terms and conditions of AWARDS enrollment. The state of Washington, its agencies and employees, are not parties to any such dispute.
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(2) On thirty days' notice, program enrollment may be limited or suspended, or the AWARDS program may be canceled in its entirety, for any reason at the discretion of the department of health.
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