Apple Health Drug Coverage Criteria

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Apple Health Drug Coverage Criteria

Clinical policies effective December 1, 2020, are now available on the Apple Health (Medicaid) Drug Coverage Criteria webpage.

  • Endocrine and Metabolic Agents: Metabolic Modifiers - elapegademase-lvlr
  • Endocrine and Metabolic Agents: Metabolic Modifiers - X-Linked Hypophosphatemia (XLH) Agents - burosumab-twza
  • Oncology: Radiopharmaceuticals – lutetium Lu 177 dotatate
  • Opthalmics: Gene Therapy – voretigene neparvovec-rzyl

These policies outline coverage and authorization criteria used by the Apple Health (Medicaid) pharmacy program.

Please email questions to AppleHealthPharmacyPolicy@hca.wa.gov