Update to HCA’s MME Conversion Calculator

Washington State Health Care Authority sent this bulletin at 01/24/2024 01:56 PM PST

January 24, 2024

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Update to HCA’s MME Conversion Calculator

Effective for claims on or after February 1, 2024, the Health Care Authority, Apple Health Fee-For-Service (FFS) is increasing the morphine milligram equivalent (MME) conversion factors used to determine total daily MME under the Apple Health Opioid Policy to the following:

Hydromorphone MME conversion factor of 5 (increased from 4)
Tramadol MME conversion factor of 0.2 (increased from 0.1)

The Apple Health MME calculator conversion factors are based on the Washington State Agency Medical Directors’ (AMDG) and CDC guidelines for prescribing opioids for pain.

Apple Health MME calculator

Opioids are limited to 120 Morphine Milligram Equivalent (MME) per day

Pharmacy claims for opioids will reject if a single prescription or a combination of prescriptions exceed the MME limit. If a pharmacy claim rejects for exceeding the MME limit, request a prior authorization.

How to request pharmacy prior authorization

Questions?

For additional questions, please email us at:

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.