On November 1, 2019, Apple Health (Medicaid) will begin using an updated clinical policy for opioid prescriptions. The Health Care Authority (HCA) has updated the clinical policy to include new criteria related to morphine milligram equivalents (MME). Forms pertaining to opioid prescriptions have also been updated.  This opioid policy will affect all clients served through Apple Health, including both fee-for-service and managed care. HCA’s opioid clinical policy is a patient safety tool that will help ensure appropriate use of opioids and reduce the risk of clients from developing opioid use disorder.

Understand how HCA's Opioid Clinical Policy for Apple Health works.

Why is HCA implementing this policy?

On October 24, 2018, President Trump signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. The SUPPORT Act is federal law that changed aspects of Washington Apple Health (Medicaid) – specifically clinical pharmacy policy and prescription drug monitoring requirements.

One significant update to the opioid policy for November 1, 2019 will be total MME per day for patients.  This policy change attempts to align the SUPPORT Act requirements with new Washington Administrative Code (WAC) on opioid prescribing.  For more detailed information, see the next section below.

HCA's Opioid Clinical Policy aligns with the requirements of the SUPPORT Act and follows recommendations from the Centers for Disease Control, the Washington State Agency Medical Directors Group, and the Bree Collaborative around safe and appropriate opioid prescribing and other best practices.

What is changing with the Apple Health Opioid Policy?

Frequently asked questions (FAQ)