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Chapter 182-530 WAC

Last Update: 9/11/13

PRESCRIPTION DRUGS (OUTPATIENT)

WAC Sections

Outpatient drug programGeneral.
Definitions.
RequirementsUse of tamper-resistant prescription pads.
COVERAGE
CoveredOutpatient drugs, devices, and drug-related supplies.
NoncoveredOutpatient drugs and pharmaceutical supplies.
AUTHORIZATION
When the department requires authorization.
How the department determines when a drug requires authorization.
The department's authorization process.
QUALITY OF CARE
Drug use review (DUR) board.
Drug use and claims review.
Washington preferred drug list (PDL).
Generics first for a client's first course of treatment.
Therapeutic interchange program (TIP).
BILLING
Billing requirementsPharmacy claim payment.
Billing requirementsPoint-of-sale (POS) system/prospective drug use review (Pro-DUR).
Billing requirementsUnit dose.
MAIL-ORDER SERVICES
Mail-order services.
REIMBURSEMENT
Reimbursement.
ReimbursementDispensing fee determination.
ReimbursementPharmaceutical supplies.
ReimbursementCompounded prescriptions.
ReimbursementOut-of-state prescriptions.
ReimbursementMiscellaneous.
ReimbursementRequesting a change.
ReimbursementUnit dose drug delivery systems.
ReimbursementCompliance packaging services.
Drug rebate requirement.
ReimbursementClients enrolled in managed care.
ReimbursementDual eligible clients/medicare.
ReimbursementClients with third-party liability.
Drugs purchased under the Public Health Service (PHS) Act.
REIMBURSEMENT METHODOLOGY
Reimbursement methodEstimated acquisition cost (EAC).
ReimbursementFederal upper limit (FUL).
ReimbursementMaximum allowable cost (MAC).
ReimbursementAutomated maximum allowable cost (AMAC).