Medication Assisted Treatment (MAT)
Apple Health has implemented new policy for coverage of Medication Assisted Treatments (MAT). Please visit Fee For Service (FFS) Drug Coverage Criteria for 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.
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 Treatment Policy and Hepatitis C Treatment Regimens.
Hepatitis C Billing and Authorization information for 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 Allison Campbell at 360-725-2028.
Where can I find?
- Medicaid Drug Coverage Lists
- FFS Drug Coverage Criteria
- 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.
- 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.
- Medical Opioid Taper Plan Calculator
- Barcode Cover Sheets