Non-contracted Drugs – Bill Fee-for-Service

Washington State Health Care Authority sent this bulletin at 07/10/2025 04:03 PM PDT

July 10, 2025

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Non-contracted Drugs – Bill Fee-for-Service

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.

Non-contracted Drug (Carve Outs) list

Refill too soon rejections

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.

Questions?

For questions, concerns, or help please contact us at:

Email Apple Health Pharmacy

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

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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