Contraceptive expedited authorization (EA) codes

Washington State Health Care Authority sent this bulletin at 05/24/2022 11:33 AM PDT

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Contraceptive expedited authorization (EA) codes

Effective for dates of service on or after June 1, 2022, all Apple Health contracted managed care (MCO) and fee-for-service (FFS) plans will require an expedited authorization (EA) code for contraceptive products billed on pharmacy claims.

The EA code will allow pharmacies to submit a claim for contraceptives based on the following criteria.

EA code	Criteria
85000000131	Used as a contraceptive, dispense 1 year
85000000132	Used as a contraceptive, dispense less than a twelve month supply due to ONE of the following: The prescriber is unwilling to change dispensed quantity to twelve-month supply The patient does not want twelve-month supply The pharmacy does not have adequate stock
85000000133	Used for other diagnosis, not related to contraception up to a 90-day supply.

A list of contraceptive products that EA applies to will be available on the Apple Health Expedited Authorization Codes and Criteria Table on or before June 1, 2022.

For additional questions, email: AppleHealthPharmacyPolicy@hca.wa.gov

For clients enrolled in an Apple Health managed care plan, contact the client’s plan.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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