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Dear Provider:
Effective for dates of service on and after March 1,
2016, Washington
Apple Health (Medicaid), administered by the Health Care Authority (the
agency), will implement the new dose limit of 40mg per day for methadone.
The
agency is implementing a daily dose limit for methadone as directed by the
Washington Medicaid Drug Utilization Review board due to concern over the
high number of methadone-related fatalities in the State of Washington.
The
agency will allow clients currently receiving methadone above the 40mg per
day limit to continue receiving methadone without authorization when the
agency has record of payment for methadone for these clients in the last two
months. Dose increases beyond the client’s 40mg per day dose will require
prior authorization.
The
agency will also continue to cover methadone without restriction for clients
actively being treated for cancer pain, using expedited authorization (EA)
code 85000000040.
For
clients new to Washington Apple Health for whom the agency does not have
current record of payment for methadone, but who have been actively taking
methadone paid for out-of-pocket or by another payer, pharmacies may request
authorization by calling 1-800-562-3022 ext. 15483, and indicating that the
methadone is a continuation of current treatment for the client.
For more information, see
the agency’s Washington
Preferred Drug List (WPDL) and Expedited Authorization List (EA).
For more information, see
the agency’s Washington
Preferred Drug List (WPDL) and Expedited Authorization List (EA).
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