Washington Apple Health Prescription Drug Provider Guide Update -
Washington State Health Care Authority sent this bulletin at 09/01/2015 11:53 AM PDT
Dear Provider:
Effective for dates of service on and
after August 12, 2015, Washington Apple Health (Medicaid),
administered by the Health Care Authority (HCA), will implement a new prior
authorization process for Medication Assisted Treatment (MAT) of substance use
disorders. Clients are no longer required to enroll in a chemical
dependency treatment program through the Behavioral Health and Service
Integration Administration (BHSIA) in order to receive drugs prescribed as MATs.
Some medications will still require authorization and will be
authorized for clients with substance use disorders. BHSIA will no longer
process authorization requests, and BHSIA authorization forms are now invalid.
To request authorization for MAT of substance use disorders,
pharmacies must submit all of the following to HCA:
13-835A, Pharmacy Information Authorization as the first page of the fax 13-012, MAT Release of Information, completed by the client The appropriate medication authorization request form completed by the prescriber:
13-013, MAT Initial Request for Buprenorphine/Naloxone (use for either buprenorphine/naloxone or buprenorphine monotherapy)
13-015, MAT Initial Request for IM Naltrexone
13-014, MAT Extension request for Buprenorphine/Naloxone
13-016, MAT Extension Request for IM Naltrexone
Detailed instructions for completing and submitting MAT authorization requests can be found on the back of each form.
You may find the agency MAT Guidelines and the required authorization forms on HCA's Medicaid
forms page.