Section 182-530-7350 - Reimbursement - Unit dose drug delivery systems(1) The medicaid agency pays for unit dose drug delivery systems only for clients residing in nursing facilities, except as provided in subsections (7) and (8) of this section.(2) Unit dose delivery systems may be either true or modified unit dose.(3) The agency pays pharmacies that provide unit dose delivery services the agency's highest allowable dispensing fee for each unit dose prescription dispensed to clients in nursing facilities. The agency reimburses ingredient costs for drugs under unit dose systems as described in WAC 182-530-7000.(4) The agency pays a pharmacy that dispenses drugs in bulk containers or multidose forms to clients in nursing facilities the regular dispensing fee applicable to the pharmacy's total annual prescription volume tier. Drugs the agency considers not deliverable in unit dose form include, but are not limited to, liquids, creams, ointments, ophthalmic and otic solutions. The agency reimburses ingredient costs as described in WAC 182-530-7000.(5) The agency pays a pharmacy that dispenses drugs prepackaged by the manufacturer in unit dose form to clients in nursing facilities the regular dispensing fee applicable under WAC 182-530-7050. The agency reimburses ingredient costs for drugs prepackaged by the manufacturer in unit dose form as described in WAC 182-530-7000.(6) The agency limits its coverage and payment for manufacturer-designated unit dose packaging to the following conditions: (a) The drug is a single source drug and a multidose package for the drug is not available;(b) The drug is a multiple source drug but there is no other multidose package available among the drug's generic equivalents; or(c) The manufacturer-designated unit dose package is the most cost-effective package available or it is the least costly alternative form of the drug.(7) The agency reimburses a pharmacy provider for manufacturer-designated unit dose drugs dispensed to clients not residing in nursing facilities only when such drugs: (a) Are available in the marketplace only in manufacturer-designated unit dose packaging; and(b) Would otherwise be covered as an outpatient drug. The unit dose dispensing fee does not apply in such cases. The agency pays the pharmacy the dispensing fee applicable to the pharmacy's total annual prescription volume tier.(8) The agency may pay for unit dose delivery systems for clients of the developmental disabilities administration (DDA) residing in approved community living arrangements.Wash. Admin. Code § 182-530-7350
Amended by WSR 16-01-046, Filed 12/9/2015, effective 1/9/201611-14-075, recodified as §182-530-7350, 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, § 388-530-7350, filed 9/26/07, effective 11/1/07.