# WAC 182-530-3000: WAC 182-530-3000. When the medicaid agency requires authorization > Washington · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_3000 ## Section - **Citation:** WAC 182-530-3000 - **Heading:** WAC 182-530-3000. When the medicaid agency requires authorization - **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 182-530-3000 ## Text Covered drugs, devices, or drug-related supplies require authorization for reimbursement when: (1) The medicaid agency's pharmacists or medical consultants: (a) Have determined that authorization for the drug, device, or drug-related supply is required, as described in WAC 182-530-3100 ; or (b) Have not yet reviewed the drug, device, or drug-related supply as described in WAC 182-530-3100 . (2) The drug, device, or drug-related supply is in a therapeutic drug class on the Washington preferred drug list and the product is one of the following: (a) Nonpreferred as described in WAC 182-530-4100 ; and (i) The prescriber is a nonendorsing practitioner; or (ii) The drug is designated as exempt from the therapeutic interchange program per WAC 182-530-4100 (6) or 182-530-4150 (2)(a); (b) Preferred for a special population or specific indication and has been prescribed by a nonendorsing practitioner under conditions for which the drug, device, or drug-related supply is not preferred; or (c) Determined to require authorization for safety. (3) The agency is promoting safety, efficacy, and effectiveness of drug therapy, or the agency identifies clients or groups of clients who would benefit from further clinical review. (4) The agency designates the prescriber(s) as requiring authorization because the prescriber(s) is under agency review or is sanctioned for substandard quality of care. (5) Utilization data indicate there are health and safety concerns or the potential for misuse and abuse. Examples of utilization concerns include: (a) Multiple prescriptions filled for the same drug in the same calendar month; (b) Prescriptions filled earlier than necessary for optimal therapeutic response; (c) Therapeutic duplication; (d) Therapeutic contraindication; (e) Excessive dosing, excessive duration of therapy, or subtherapeutic dosing as determined by FDA labeling or the compendia of drug information; and ization concerns include: (a) Multiple prescriptions filled for the same drug in the same calendar month; (b) Prescriptions filled earlier than necessary for optimal therapeutic response; (c) Therapeutic duplication; (d) Therapeutic contraindication; (e) Excessive dosing, excessive duration of therapy, or subtherapeutic dosing as determined by FDA labeling or the compendia of drug information; and (f) Number of prescriptions filled per month in total or by therapeutic drug class. (6) The pharmacy requests reimbursement in excess of the maximum allowable cost and the drug has been prescribed with instructions to dispense as written. ## 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) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_530_3000. Check the current official text before relying on it. Not legal advice.