The State Pharmacy Association’s (WSPA) bill, HB 1445  by Rep. My Lihn Thai (D), clarifies that the reconstitution and mixing of nonsterile products according to FDA labeling and according to a prescription, often referred to as simple compounding, is not compounding. The bill was signed by Gov. Jay Inslee and will go into effect on July 25, 2021.

Also in Washington,  Gov. Jay Inslee (D) signed into law the Second Substitute to HB 1161  which modified the requirements for the manufacturer’s drug take-back programs under the Department of Health.

Also in Washington, Apple Health (Medicaid), administered by the Health Care Authority will implement changes to the State Maximum Allowable Costs (SMAC) list for the fee-for-service (FFS) Prescription Drug Program. on June 1, 2021. The full SMAC list can be found on the agency’s Provider billing guides and fee schedules website under the Prescription Drug Program and applies to claims billed FFS.

Also in Washington, HB 1127  by Rep. Vandana Slatter establishes privacy and security standards for COVID-19 health data passed both houses and was sent to Gov. Jay Inslee (D) to sign into law.

Also in Washington, the Health Care Authority (HCA) sent a Provider Alert informing providers about updates to the COVID-19 vaccine clinical policy regarding the roster billing for COVID-19 vaccine administration. When billing for vaccines for fee-for-service clients, there are three options:

  1. Bill each individual claim.
  2. Use batch 837.
  3. Template billing.

HCA is no longer requests that you bill the vaccine with the vaccine administration code. If you do submit a claim with both codes, HCA will not pay for the vaccine but will pay for the administration of the COVID-19 vaccine. These policies apply to both fee-for-service (FFS) providers and HCA-contracted managed care organizations (MCOs). For more information go to Apple Health (Medicaid) COVID-19 vaccine clinical policy under Reimbursement information and billing guidance.

Lastly in Washington, the Office of the Insurance Commissioner extended two Emergency Orders until May 16, 2021:

  • Notice requires health insurers to waive copays and deductibles for coronavirus testing. It also requires insurers to allow a one-time early refill for prescription drugs; to suspend any prior authorization requirement for treatment or testing of Covid-19, and to allow enrollees to be treated by out-of-network providers within a reasonable distance at no additional cost when the insurer does not have enough in-network medical providers.
  • Notice concerning insurance coverage for coronavirus diagnostic testing, prohibiting all health carriers from balance billing for Covid-19 diagnostic testing processed by out-of-network laboratories, when determined to be medically necessary. It also requests that insurers notify the agency if out-of-network laboratories submit claims but have not published a cash price or fail to accept such a price.

For more information, contact NACDS’ Mary Staples at 817-442-1155.