Apple Health Drug Coverage Criteria

Washington State Health Care Authority sent this bulletin at 02/27/2023 11:22 AM PST

February 27, 2023

Apple Health Drug Coverage Criteria

Updated clinical policies now available on the Apple Health (Medicaid) Drug Coverage Criteria webpage. These policies outline coverage criteria and authorization requirements for Apple Health (Medicaid):

Androgenic Agents – Testosterone Replacement Therapy (TRT)
Antidiabetics – GLP-1 Agonists
Medication Treatment for Substance Use Disorders (SUDs) - Transmucosal Buprenorphine
Oncology – Tyrosine Kinase Inhibitors – Oral

Please email questions to AppleHealthPharmacyPolicy@hca.wa.gov

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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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.