Prescription Pharmacists RCW 18.64.530 Forms may not include any provision conflicting with the following: – Eye Drop A pharmacist is authorized, without consulting a physician or obtaining Drug Services (EHB) Refills a new prescription or refill authorization from a physician, to provide (Cont’d) for one early refill of a prescription for topical ophthalmic products if: RCW • The refill is requested by a patient at or after seventy percent of the 18.64.530(1) predicted days of use of (1)(a) The date the original prescription was dispensed to the patient; or (1)(b) The date that the last refill of the prescription was dispensed to the patient; RCW The prescriber indicates on the original prescription that a 18.64.530(2) specific number of refills will be needed; and RCW The refill does not exceed the number of refills that the prescriber 18.64.530(3) indicated. Preventive and Definition of 42 USC §18021 Plan must cover "preventive and wellness services, including chronic Wellness Preventive (a)(1)(B); disease management" in a manner substantially equal to the Services, and Wellness 42 USC plan. For purposes of determining a plan's actuarial value, Including Services 18022(b)(1)(I) an issuer must classify as preventive and wellness services, including Chronic WAC chronic disease management, the services that identify or prevent the Disease onset or worsening of disease or disease conditions, illness or injury, Management often asymptomatic; services that assist in the multidisciplinary (EHB) management and treatment of chronic diseases; and services of particular preventative or early identification of disease or illness of value to specific populations, such as women, children and seniors. Requirements WAC If the plan does not have in its network a provider who can perform WAC the particular service, then the plan must cover the item or service 284-43-5800(4) when performed by an out-of-network provider and must not impose cost-sharing with respect to the item or service.
Prescription Drug Services (EHB) (Cont’d) Pharmacists – Eye Drop Refills RCW 18.64.530 Forms may not include any provision conflicting with the following: A pharmacist is authorized, without consulting a physician or obtaining a new prescription or refill authorization from a physician, to provide for one early refill of a prescription for topical ophthalmic products if: RCW 18.64.530(1) • The refill is requested by a patient at or after seventy percent of the predicted days of use of (1)(a) The date the original prescription was dispensed to the patient; or (1)(b) The date that the last refill of the prescription was dispensed to the patient; RCW 18.64.530(2) The prescriber indicates on the original prescription that a specific number of refills will be needed; and RCW 18.64.530(3) The refill does not exceed the number of refills that the prescriber indicated. Preventive and Wellness Services, Including Chronic Disease Management (EHB) Definition of Preventive and Wellness Services 42 USC §18021 (a)(1)(B); 42 USC 18022(b)(1)(I) WAC Plan must cover "preventive and wellness services, including chronic disease management" in a manner substantially equal to the plan. For purposes of determining a plan's actuarial value, an issuer must classify as preventive and wellness services, including chronic disease management, the services that identify or prevent the onset or worsening of disease or disease conditions, illness or injury, often asymptomatic; services that assist in the multidisciplinary management and treatment of chronic diseases; and services of particular preventative or early identification of disease or illness of value to specific populations, such as women, children and seniors. Requirements WAC WAC 284-43-5800(4) If the plan does not have in its network a provider who can perform the particular service, then the plan must cover the item or service when performed by an out-of-network provider and must not impose cost-sharing with respect to the item or service.
cl-forms-19-hmo-sg-analyst-checklist.docx