Billing L&I for Pharmacy Services

Pharmacy Fee Schedule

Payment for drugs, including all oral non-legend drugs, will be based on the pricing methodology described below.

Drug type Payment method
Generic AWP less 50% + $4.50 professional fee.
Single or multisource brand AWP less 10% + $4.50 professional fee.
Brand with generic equivalent (dispense as written only). AWP less 10% + $4.00 professional fee.
Compound prescriptions. Allowed cost of ingredients + $4.50 professional fee + $4.00 compounding time fee (per 15 minutes).

Refer to WAC 296-20-01002 for definition of average wholesale price (AWP).

View L&I's Outpatient Formulary.

Orders for over-the-counter non-oral drugs or non-drug items must be written on standard prescription forms. These items are to be priced on a 40% margin. Prescription drugs and oral or topical over-the-counter medications are nontaxable (RCW 82.08.0281 (www.leg.wa.gov)).

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