Please read the following update from the HCA:
The Health Care Authority (HCA) would like to remind providers of the Washington Apple Health fee-for-service (FFS) expedited authorization (EA) criteria for buprenorphine monotherapy for pregnant clients. This EA allows pharmacies to submit a claim for a seven (7) day supply without a prior authorization. After submitting a claim with this EA, pharmacies and/or providers should request a prior authorization for further fills.
| Drug |
Code |
Criteria |
Buprenorphine
|
077
|
Seven (7) day induction of buprenorphine monotherapy for pregnant clients
|
In addition to the EA criteria, pharmacists also have the option to dispense an emergency fill, at the discretion of the pharmacist, for any medication to meet the immediate and/or urgent needs of the client, including prescriptions for buprenorphine monotherapy.
For clients enrolled in Apple Health managed care plan,
contact the client’s plan.
Resources:
•
HCA’s Buprenorphine Containing Products Policy
•
Apple Health FFS EA list
•
HCA’s Emergency Fill Policy
For additional questions, email:
applehealthpharmacypolicy@hca.wa.gov.