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PDFWAC 182-530-4100

Medicaid preferred drug list (medicaid PDL).

(1) The medicaid agency contracts with a vendor to perform systematic evidence-based drug reviews.
(2) The pharmacy and therapeutics (P&T) committee or the drug use review (DUR) board reviews and evaluates the safety, efficacy, and outcomes of prescribed drugs, using evidence-based drug reviews.
(3) The P&T committee makes recommendations to state agencies as to which drugs to include on the Washington PDL under chapter 182-50 WAC. The DUR board makes recommendations to the medicaid agency about which additional drug classes to include in the medicaid PDL.
(4) The agency director or designee makes the final selection of drugs or drug classes included on the medicaid PDL.
(5) Drugs in a drug class on the medicaid PDL which are not on the Washington PDL are not subject to therapeutic interchange program (TIP) and dispense as written (DAW) rules under WAC 182-530-4150.
(6) Drugs in a drug class on the medicaid PDL that have not been reviewed by the P&T committee or the DUR board may be treated as nonpreferred drugs and are not subject to DAW or TIP.
(7) A nonpreferred drug is considered for authorization after the client has:
(a) Tried and failed or is intolerant to at least one preferred drug; and
(b) Met agency-established criteria for the nonpreferred drug.
(8) Drugs in a drug class on the medicaid PDL may be designated as preferred drugs for special populations or specific indications.
(9) Drugs in a drug class on the medicaid PDL may require authorization regardless of preferred or nonpreferred status.
(10) When a preferred innovator drug or biological product on the medicaid PDL loses its patent, the agency may:
(a) Designate an available, equally effective, generic equivalent, or biosimilar biological product as a preferred drug; and
(b) Make the innovator drug or biological product nonpreferred.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 17-07-001, § 182-530-4100, filed 3/1/17, effective 4/1/17; WSR 15-12-093, § 182-530-4100, filed 6/2/15, effective 7/3/15. WSR 11-14-075, recodified as § 182-530-4100, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.09.700, 74.08.090, 2009 c 575. WSR 10-06-011, § 388-530-4100, filed 2/19/10, effective 3/22/10. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.700, 2008 c 245. WSR 08-21-107, § 388-530-4100, filed 10/16/08, effective 11/16/08. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. WSR 07-20-049, § 388-530-4100, filed 9/26/07, effective 11/1/07.]
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