Section 284-180-130 - DefinitionsExcept as defined in other subchapters and unless the context requires otherwise, the following definitions apply throughout this chapter:
(1) "Affiliate" or "affiliated employer" has the same meaning as the definition of affiliate or affiliated employer in RCW 48.200.020.(2) "Certification" has the same meaning as the definition of certification in RCW 48.43.005.(3) "Corporate umbrella" means an arrangement consisting of, but not limited to, subsidiaries and affiliates operating under common ownership or control.(4) "Employee benefits programs" has the same meaning as the definition of employee benefits program in RCW 48.200.020.(5) "Generally available for purchase" means available for purchase by multiple pharmacies within the state of Washington from national or regional wholesalers.(6) "Health care benefit manager" has the same meaning as the definition of health care benefit manager in RCW 48.200.020.(7) "Health care provider" or "provider" has the same meaning as the definition of health care provider in RCW 48.43.005.(8) "Health care services" has the same meaning as the definition of health care services in RCW 48.43.005.(9) "Health carrier" has the same meaning as the definition of health carrier in RCW 48.43.005.(10) "Laboratory benefit manager" has the same meaning as the definition of laboratory benefit manager in RCW 48.43.020.(11) "Mental health benefit manager" has the same meaning as the definition of mental health benefit manager in RCW 48.200.020.(12) "Net amount" means the invoice price that the pharmacy paid to the supplier for a prescription drug that it dispensed, plus any taxes, fees or other costs, minus the amount of all discounts and other cost reductions attributable to the drug.(13) "Network" has the same meaning as the definition of network in RCW 48.200.020.(14) "Oversight activities" includes all work done by the commissioner to ensure that the requirements of chapter 48.200 RCW are properly followed and in fulfilling its duties as required under chapter 48.200 RCW.(15) "Person" has the same meaning as the definition of person in RCW 48.200.020.(16) "Pharmacy benefit manager" has the same meaning as the definition of pharmacy benefit manager in RCW 48.200.020.(17) "Predetermined reimbursement cost" means maximum allowable cost, maximum allowable cost list, or any other benchmark price utilized by the pharmacy benefit manager, including the basis of the methodology and sources utilized to determine multi source generic drug reimbursement amounts. However, dispensing fees are not included in the calculation of predetermined reimbursement costs for multi-source generic drugs.(18) "Radiology benefit manager" has the same meaning as the definition of radiology benefit manager in RCW 48.200.020.(19) "Readily available for purchase" means manufactured supply is held in stock and available for order by more than one pharmacy in Washington state when such pharmacies are not under the same corporate umbrella.(20) "Retaliate" means action, or the implied or stated threat of action, to decrease reimbursement or to terminate, suspend, cancel or limit a pharmacy's participation in a pharmacy benefit manager's provider network solely or in part because the pharmacy has filed or intends to file an appeal under RCW 48.200.280.(21) "Unsatisfied" means that the network pharmacy did not receive the reimbursement that it requested at the first tier appeal.(22) "Utilization review" has the same meaning as the definition of utilization review in RCW 48.43.005.Wash. Admin. Code § 284-180-130
Adopted by WSR 17-01-139, Filed 12/20/2016, effective 1/1/2017Amended by WSR 21-02-034, Filed 12/29/2020, effective 1/1/2022