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Washington Apple Health (Medicaid) has updated the Non-contracted Drug (Carve Outs) list. Non-contracted drugs must be billed to Fee-for-Service (FFS) regardless of what Apple Health Plan the client is enrolled.
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Pharmacies that bill Non-contracted Drugs to the Managed Care Organization (MCO) and then to FFS will experience a refill too soon rejection due to a system issue that will not be corrected until late August 2025. To prevent this, pharmacies should refer to the Non-contracted Drug (Carve Outs) list and bill claims directly to FFS.
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For questions, concerns, or help please contact us at:
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