Effective April 2, 2013, the Medicaid program of the Health Care Authority is discontinuing development and implementation of the Fee-for-Service (FFS) formulary. HCA is withdrawing the related State Plan Amendment previously submitted to the Centers for Medicare and Medicaid Services. Based on the small proportion of clients remaining under the Medicaid FFS pharmacy benefit, HCA has concluded that it is no longer an effective use of state resources to continue the development of a FFS formulary at this time.
Health Advisory: Unintentional overdose deaths are associated with methadone and other opioids. The Pharmacy and Therapeutics Committee has asked the Health Care Authority to distribute a special health advisory to pharmacists and prescribers. This was distributed to Medicaid pharmacies and providers statewide on December 27, 2011.
Supplemental Rebate Offers
Electronic Submission is required and should be sent to Contracts@hca.wa.gov.
The subject line should say: WA Medicaid Supplemental Rebate Offers. Faxes or written submissions will not be accepted. No bids will be entertained until the drug class is evaluated per the P&T Committee schedule.
Please direct any questions about the supplemental rebate bid process to Amy Irwin at 360-725-1725.
The Health Care Authority has established the RSV/Synagis® season as December 1, 2012, through April 30, 2013. For additional information see Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program Medicaid Provider Guide.
Where can I find?
- Medicaid Drug Coverage Lists
- Participating Drug Rebate Manufacturers
- Pharmacy News and Announcements. Information on new drugs, Apple Health (Managed Care) clients that self refer, Second Opinion Network Providers list, Fair Hearings, information on transportation for clients, Medicare Part D, Preferred Drug List (PDL), Mental Health Pharmaceutical News, and Reports.
- Pharmacy Prior Authorization. Prior Authorization fax forms and the PDL drug list.
- Prescription Billing. Current Expedited Authorization (EA) list, Prescription Drug Program Billing Instructions, HRSA Preferred Drug Lists (PDL), Numbered Memorandums.
- Instructions for requesting 12 month patient history
- How to become an Endorsing Prescriber
- Pharmacy Reimbursement. Request to Change Reimbursement fax form, current SMAC list, AWP-50% exclusions, Federal Upper Limits and NCPDP Billing Standards.
- Criteria for authorization of Suboxone
- Medical Opioid Taper Plan Calculator
- Barcode Cover Sheets