Apple Health (Medicaid): Provider Alert

Dear Provider,

Effective for dates of service on or after May 1, 2017, Washington Apple Health (Medicaid) will require prior authorization for Fortamet® (metformin SR 24HR osmotic), Glumetza® (metformin SR 24HR modified release), and their generic equivalents for the Fee-for-Service (FFS) Prescription Drug Program.

A less costly, covered alternative that does not require prior authorization is generic Glucophage XR® (metformin SR 24HR).  

To request prior authorization, please complete and submit the Pharmacy Information Authorization (HCA 13-835A) form and fax to 1-866-668-1214 or call Pharmacy Authorization at 1-800-562-3022. Forms can be found on the agency’s Forms & publications web page.

Please do not reply directly to this message. If you have feedback or questions, please visit the HCA website for contact information.

About Washington State Health Care Authority
HCA oversees the state’s top two health care purchasers — Washington Apple Health (Medicaid) and the Public Employee Benefits Board Program. We work with partners to help ensure Washingtonians have access to better health and better care at a lower cost. For more information, visit www.hca.wa.gov.