Pharmacy point of sale replacement project

The Health Care Authority (HCA) is beginning 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 will replace our current system with a new POS solution that offers the latest functionality, features, and technologies to better meet the needs of Washington’s 2.2 million Apple Health (Medicaid) recipients.

Project overview

The current Pharmacy 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 future solution will build 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. 

The current projected go-live date is March 26, 2023.

For managed care organizations

Changes are coming to the companion guide for encounter submissions. Review the draft encounter companion guide and FAQ to prepare for the changes.  

For providers and pharmacies

There will be minor changes for pharmacies, including the BIN/PCN and Group they bill for Apple Health (Medicaid) FFS pharmacy claims. Those new numbers will be provided as we get closer to go-live. We will be encouraging pharmacies to get all their reversals submitted before the go-live to streamline these changes. Please submit additional questions to hcamcprograms@hca.wa.gov.

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Pharmacy Point of Sale Replacement Project - frequently asked questions

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