Apple Health has updated its Hepatitis C treatment policy for immune modulators and anti-viral medications to treat chronic active Hepatitis C virus (HCV) infection. Clients whose requests for authorization were initially denied may now qualify for treatment.
Medication Assisted Treatment (MAT)
Effective for dates on and after October 1, 2015 all medications prescribed as medication assisted treatment (MAT) to clients enrolled in an Apple Health Managed Care Organization (MCO) must be billed directly to the client's plan.
Apple Health will have an updated policy effective October 1, 2015 for coverage of Medication Assisted Treatments (MAT). Please visit Fee For Service (FFS) Drug Coverage Criteria for current and updated treatment policy, guidelines and forms for all Medication Assisted Treatments (MAT).
Drug Coverage Criteria
Fee For Service (FFS) Drug Coverage Criteria is a new web page where agency guidelines and criteria will be housed. Please continue to check this page for added criteria and updates.
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 Allison Campbell at 360-725-2028.
Prescription Drug Program – Discount Card
All prescription drugs are eligible for a discount. Find out how to get your prescription drug Discount Card and start saving.
Federal Upper Limits (FUL)
Effective April 1, 2016: As required under federal rule, the Apple Health fee-for-service (FFS) Prescription Drug Program will add the new Affordable Care Act FULs into pharmacy point-of-sale claim payment algorithms no later than May 1, 2016.
If a FUL for a product is the lowest price on the payment file, it is the amount that will be paid. Find out more on how the new FULs are set and how to request a change in reimbursement for a FFS claim.
Additional information is available at Medicaid.gov or send questions to: PharmacyRates@hca.wa.gov.
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