Prescription Drug Program Update


 

Dear Provider: 

Effective for claims with dates of service on and after January 1, 2016, Washington Apple Health (Medicaid), administered by the Health Care Authority, will require prior authorization for the topical testosterone products listed below when billing for pharmacy services:

  • Androderm® 2mg/24hr transdermal patch
  • Androderm® 4mg/24hr transdermal patch
  • Androgel® gel 1%
  • Androgel® gel 1.62%
  • Fortesta® 2% gel
  • Natesto® nasal gel
  • Testim® gel 1%
  • Testosterone gel 1%
  • Testosterone gel 2%
  • Vogelxo® gel 1%

Effective retroactively for claims with dates of service on and after October 1, 2015, retail pharmacies can bill the following levonorgestrel IUD products through the pharmacy point-of-sale system:

  • Lilleta®
  • Mirena®
  • Skyla®

For additional billing information, please see the current Prescription Drug Program Provider Guide