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PDFWAC 182-530-7250

ReimbursementMiscellaneous.

(1) The medicaid agency reimburses for covered drugs, devices, and drug-related supplies provided or administered by nonpharmacy providers under specified conditions, as follows:
(a) The agency reimburses for drugs administered or prepared and delivered for individual use by an authorized prescriber during an office visit according to specific program rules found in:
(i) Chapter 182-531 WAC, Physician-related services;
(ii) Chapter 182-532 WAC, Reproductive health/family planning only/TAKE CHARGE; and
(iii) Chapter 182-540 WAC, Kidney disease program and kidney center services.
(b) Providers who are purchasers of Public Health Services (PHS) discounted drugs must comply with PHS 340B program requirements and Washington medicaid requirements for 340B providers participating with medicaid. (See WAC 182-530-7900.)
(2) The agency may request providers to submit a current invoice for the actual cost of the drug, device, or drug-related supply billed. If an invoice is requested, the invoice must show the:
(a) Name of the drug, device, or drug-related supply;
(b) Drug or product manufacturer;
(c) NDC of the product or products;
(d) Drug strength;
(e) Product description;
(f) Quantity; and
(g) Cost, including any discounts or free goods associated with the invoice.
(3) The agency does not reimburse providers for the cost of vaccines obtained through the state department of health (DOH). The agency does pay physicians, advanced registered nurse practitioners (ARNP), and pharmacists a fee for administering the vaccine.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 17-07-001, § 182-530-7250, filed 3/1/17, effective 4/1/17; WSR 16-01-046, § 182-530-7250, filed 12/9/15, effective 1/9/16. WSR 11-14-075, recodified as § 182-530-7250, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. WSR 07-20-049, § 388-530-7250, filed 9/26/07, effective 11/1/07.]
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