Section 182-530-7250 - Reimbursement-Miscellaneous(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 programs; and(iii) Chapter 182-540 WAC, Kidney disease program and kidney center services.(b) Providers who are participating PHS-qualified covered entities under section 340B of the Public Health Services (PHS) Act 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 require providers to submit a current invoice for the actual cost of the drug, device, or drug-related supply billed. If an invoice is required, 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;(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.Wash. Admin. Code § 182-530-7250
Amended by WSR 16-01-046, Filed 12/9/2015, effective 1/9/2016Amended by WSR 17-07-001, Filed 3/1/2017, effective 4/1/2017Amended by WSR 23-11-007, Filed 5/4/2023, effective 6/4/2023Amended by WSR 24-08-061, Filed 3/29/2024, effective 5/1/202411-14-075, 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. 07-20-049, § 388-530-7250, filed 9/26/07, effective 11/1/07.