WAC 296-20-170
Pharmacy -- Acceptance of rules and fees. (1) Acceptance and filling of a prescription for a worker
entitled to benefits under the industrial insurance law,
constitutes acceptance of the department's rules and fees.
(2) When there is questionable eligibility, (i.e., no
claim number, prescription is for medication other than
usually prescribed for industrial injury; or pharmacist has
reason to believe claim is closed or rejected), the pharmacist
may require the worker to pay for the prescription.
(a) The pharmacist must furnish the worker with a signed
receipt and a nonnegotiable copy of the prescription including
national drug code and quantity or a completed department
pharmacy bill form signed in the appropriate areas verifying
worker has paid for the prescribed item(s) in order for the
worker to bill the department or self-insurer for
reimbursement.
(b) The worker may not be charged more than the amount
allowable by the department or self-insurer.
(c) The worker must submit such reimbursement request
within one year of the date of service.
See WAC 296-20-020 for details on providing a refund.
(3) Pharmacies may bill the department for initial
prescription drugs prior to claim acceptance upon the
presentation to the pharmacy of a state fund identification
card or a copy of the Report of Industrial Injury or
Occupational Disease.
[Statutory Authority: RCW 51.04.020, 51.04.030 and 2007 c
134. 08-02-021, § 296-20-170, filed 12/21/07, effective
1/21/08. Statutory Authority: RCW 51.04.020. 03-21-069, §
296-20-170, filed 10/14/03, effective 12/1/03. Statutory
Authority: RCW 51.04.020, 51.04.030 and 1993 c 159.
93-16-072, § 296-20-170, filed 8/1/93, effective 9/1/93.
Statutory Authority: RCW 51.04.020(4) and 51.04.030.
86-06-032 (Order 86-19), § 296-20-170, filed 2/28/86,
effective 4/1/86. Statutory Authority: RCW 51.04.020(4),51.04.030
, and 51.16.120(3). 80-18-033 (Order 80-24), §
296-20-170, filed 12/1/80, effective 1/1/81; Order 76-34, §
296-20-170, filed 11/24/76, effective 1/1/77.]