Washington Apple Health Prescription Drug Provider Guide Update -

HCA Apple Health

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.

For additional information please see the Prescription Drug Program Medicaid Provider Guide.