Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-530 - Prescription drugs (outpatient) › MAIL-ORDER SERVICES › Section 182-530-6000 - Mail-order and specialty pharmacy services

Current through Register Vol. 24-14, July 15, 2024
Clients may elect to receive pharmacy services through any
					 mail-order or specialty pharmacy enrolled with the agency.
(1) Mail-order pharmacies or specialty
				  pharmacies licensed to do business in Washington state under
				  RCW
				  18.64.360 may enroll with the agency in the
				  same manner as other pharmacies according to chapter 182-502 WAC, including
				  out-of-state mail-order or specialty pharmacies.
(2) The agency considers mail-order and
				  specialty classes of trade the same as retail class of trade for the purpose of
				  enrollment with the agency. When enrolling with the agency, a mail-order or
				  specialty pharmacy must enroll as a retail pharmacy unless participating with
				  the agency under a mail-order or specialty pharmacy contract. Mail-order and
				  specialty pharmacies cannot enroll under a mail-order designation by taxonomy
				  or other indicator except when providing services under a mail-order contract
				  with the agency separate from and in addition to the pharmacy's core provider
				  agreement.
(3) Out-of-state
				  pharmacies must comply with all applicable Revised Code of Washington and
				  Washington Administrative Code when serving agency clients.
(4) The provisions of this chapter apply
				  equally to all pharmacies and services provided by pharmacies regardless of the
				  pharmacy's class of trade, except when those services are provided under a
				  contract with the agency separate from and in addition to the pharmacy's core
				  provider agreement.
(5) The agency
				  may contract with one or more mailorder or specialty pharmacies separate from
				  and in addition to the pharmacy's core provider agreement.
(a) Provisions of the contract may differ
				  from requirements detailed in this chapter including, but not limited to,
				  reimbursement rates, dispensing limitations, and authorization
				  requirements.
(b) Mail-order or
				  specialty pharmacy contract provisions supersede individual sections or
				  subsections of this chapter when specifically cited in contract, leaving in
				  effect all other provisions of this chapter.
(c) Mail-order contract provisions for a
				  dispensing pharmacy must not allow for a higher reimbursement than is allowed
				  under this chapter for a retail pharmacy.
(d) When opening enrollment under a
				  mail-order or specialty contract, the agency will make publicly available the
				  contract provisions and minimum requirements to participate under the contract
				  including, but not limited to, the reimbursement rate and methodology the
				  provider must accept. Any pharmacy enrolled with Washington medicaid as a
				  billing provider may choose to accept and participate with the agency under the
				  terms of the mail-order or specialty pharmacy contract.
(e) The agency may use the same contract for
				  both mailorder and specialty pharmacies, or may have separate standard
				  contracts for each class of trade.
(f) The agency may base contract provisions
				  on information supplied through a request for information to interested parties
				  before making the finalized contract publicly available.