Section 182-530-6000 - Mail-order and specialty pharmacy services 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.(6) The agency may implement programs or contract provisions that provide favorable conditions to contracted mail-order pharmacies, specialty pharmacies, or clients to encourage participation by pharmacies or the use of mailorder and specialty services by clients.(7) The agency may designate specific products or classes of products to be made available to clients through mail-order or specialty pharmacies only.Wash. Admin. Code § 182-530-6000
Amended by WSR 16-01-046, Filed 12/9/2015, effective 1/9/2016Amended by WSR 17-07-001, Filed 3/1/2017, effective 4/1/201711-14-075, recodified as §182-530-6000, 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, § 388-530-6000, filed 9/26/07, effective 11/1/07.