# WAC 182-530-2100: WAC 182-530-2100. Noncovered — Outpatient drugs and pharmaceutical supplies

> Washington · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_2100

## Section

- **Citation:** WAC 182-530-2100
- **Heading:** WAC 182-530-2100. Noncovered — Outpatient drugs and pharmaceutical supplies
- **Jurisdiction:** Washington
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Washington Administrative Code / Title 182 / Chapter 182-530 / Section 182-530-2100

## Text

(1) The medicaid agency does not cover:
(a) A drug that is:
(i) Not approved by the Food and Drug Administration (FDA); or
(ii) Prescribed for a nonmedically accepted indication, including diagnosis, dose, or dosage schedule that is not evidenced-based.
(b) A drug prescribed:
(i) For weight loss or gain;
(ii) For infertility, frigidity, impotency;
(iii) For sexual or erectile dysfunction;
(iv) For cosmetic purposes or hair growth; or
(v) For treatment of cough or cold symptoms, except as listed in WAC 182-530-2000 (1)(h).
(c) Drugs used to treat sexual or erectile dysfunction, in accordance with section 1927 (d)(2)(K) of the Social Security Act, unless such drugs are used to treat a condition other than sexual or erectile dysfunction, and these uses have been approved by the Food and Drug Administration.
(d) Drugs listed in the federal register as "less-than-effective" ("DESI" drugs) or which are identical, similar, or related to such drugs.
(e) Outpatient drugs for which the manufacturer requires as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or manufacturer's designee.
(f) A product:
(i) With an obsolete National Drug Code (NDC) for more than two years;
(ii) With a terminated NDC;
(iii) Whose shelf life has expired; or
(iv) Which does not have an eleven-digit NDC.
(g) Over-the-counter (OTC) drugs, vitamins, and minerals, except as allowed under WAC 182-530-2000 (1)(h).
(h) Any drug regularly supplied by other public agencies as an integral part of program activity (e.g., immunization vaccines for children).
(i) Free pharmaceutical samples.
(2) A noncovered drug can be requested through the exception to rule process as described in WAC 182-501-0160 .
(3) For clients age 20 and younger, providers must follow the rules for the early periodic screening, diagnosis, and treatment program; see chapter 182-534 WAC.

## Nearby sections

- [WAC 182-530-1000 WAC 182-530-1000. Outpatient drug program—General](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_1000.md)
- [WAC 182-530-1050 WAC 182-530-1050. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_1050.md)
- [WAC 182-530-1075 WAC 182-530-1075. Requirements—Use of tamper-resistant prescription pads](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_1075.md)
- [WAC 182-530-1080 WAC 182-530-1080. Requirements for prescribing and dispensing controlled substances — Prescription monitoring program (PMP)](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_1080.md)
- [WAC 182-530-2000 WAC 182-530-2000. Covered — Outpatient drugs, devices, and drug-related supplies](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_2000.md)
- [WAC 182-530-2100 WAC 182-530-2100. Noncovered — Outpatient drugs and pharmaceutical supplies](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_2100.md)
- [WAC 182-530-3000 WAC 182-530-3000. When the medicaid agency requires authorization](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_3000.md)
- [WAC 182-530-3100 WAC 182-530-3100. How the medicaid agency determines when a drug requires authorization](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_3100.md)
- [WAC 182-530-3200 WAC 182-530-3200. The medicaid agency's authorization process](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_3200.md)
- [WAC 182-530-4000 WAC 182-530-4000. Drug use review (DUR) board](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_4000.md)
- [WAC 182-530-4050 WAC 182-530-4050. Drug use and claims review](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_4050.md)
- [WAC 182-530-4100 WAC 182-530-4100. Medicaid preferred drug list (medicaid PDL)](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_4100.md)
- [WAC 182-530-4125 WAC 182-530-4125. Generics first for a client's first course of treatment](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_4125.md)
- [WAC 182-530-4150 WAC 182-530-4150. Therapeutic interchange program (TIP)](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_4150.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_2100. Check the current official text before relying on it. Not legal advice.