Hepatitis C Authorization and Treatment Policy

Effective for dates on and after January 1, 2015, immune modulators and anti-viral medications to treat chronic Hepatitis C virus (HCV) infection will be excluded from the Apple Health Managed Care Organizations’ (MCO) benefit and will be covered through the Apple Health Fee-For-Service (FFS) program.

All coverage for immune modulators and anti-viral medications to treat HCV will be covered through the FFS program for Apple Health clients, according to Health Care Authority’s Hepatitis C Prior Authorization and Treatment Policy.

Hepatitis C Billing and Authorization information for Pharmacies

Attention Pharmacies!

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 360-725-1583.

For Pharmacies

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.

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