Pharmacy Point of Sale Replacement Project

The Health Care Authority (HCA) has begun its journey of modularizing its Medicaid Management Information System (MMIS) with the replacement of the first module - the Pharmacy Point of Sale (POS) system. The Pharmacy POS Replacement Project has replaced our current system with a new POS solution that offers the latest functionality, features, and technologies to better meet the needs of Washington’s 2 million Apple Health (Medicaid) recipients.

Project overview

The Pharmacy Point of Sale (POS) system encompasses the automated functions necessary to receive and adjudicate all pharmacy fee-for-service (FFS) claims, managed care organization encounters and process drug rebate invoicing. The new solution builds on these features and include a cloud- hosted architecture that is flexible and scalable to meet future Washington State business needs and federal requirements.

Additional features include a secure web portal for drug labelers to retrieve quarterly invoices and claim level detail, more robust prior authorization workflow processes for state staff and rules-engine driven functionality to assist with easy Washington program updates. 

Project status

The new system went live Saturday, June 8.

For managed care organizations

Changes are now in place with the final encounter companion guide. Read frequently asked questions about the changes.

As a result of integrating the preferred drug list (PDL) into the new system, some necessary drug status and class changes were identified. HCA shared all changes to the PDL with the MCOs in the updated file layout in direct emails.

Submit questions to HCA managed care programs.

For providers and pharmacies

There are minor changes for pharmacies, including the BIN/PCN and Group they bill for Apple Health FFS pharmacy claims as well as the fax number for prior authorizations.

View the payer sheet effective June 8, 2024. Be sure to update to the new billing information for FFS clients:

  • New BIN: 024822
  • New PCN: DRWAPROD
  • New group: CAID

The new fax number for prior authorizations is (833) 991-0704. This is only for pharmacy prior authorizations.

To receive the latest information about the new POS and things providers and pharmacies need to know, sign up for the provider email list.

For drug manufacturers

Starting with the 2nd quarter in August 2024, drug rebate invoices will be only be found online in an application called RebateWeb where drug manufacturers can access invoices with claim-level detail.

If you are not registered for RebateWeb with other states:

If you are already registered for RebateWeb in other states, you will see Washington available as a program to view your invoices for 2Q2024.

Use the Manufacturer Contact Change Form to make any changes to legal, invoice, and technical contact information.

Stay informed

View Pharmacy Point of Sale Replacement Project frequently asked questions. 

Contact

Email: Apple Health Pharmacy Policy