Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-530 - Prescription drugs (outpatient)
REIMBURSEMENT METHODOLOGY
Section 182-530-8150 - Reimbursement-Automated maximum allowable cost (AMAC)

(1) The medicaid agency uses the automated maximum allowable cost (AMAC) pricing methodology for multiple-source drugs that are:

(2) The agency establishes AMAC as a specified percentage of the published national average drug acquisition cost (NADAC) or other nationally accepted pricing source in order to estimate acquisition cost.

(3) The agency sets the percentage discount from NADAC for AMAC reimbursement using any of the information sources identified in WAC 182-530-8000.

(4) The agency may set AMAC reimbursement at different percentage discounts from NADAC for different multiple source drugs. The agency considers the same factors as those in WAC 182-530-8000.

(5) AMAC reimbursement for all products with the same ingredient, form and strength is at the AMAC determined for the second lowest priced product, or the AMAC of the lowest priced drug from a manufacturer with a current, signed federal rebate agreement.

(6) The agency recalculates the AMAC each time the drug file contractor provides a pricing update.

(7) Except as provided in WAC 182-530-7300, the agency reimburses at the lowest of the rates calculated under the methods listed in WAC 182-530-7000.