Pharmacy prior authorization requests for Apple Health Fee-for-Service (FFS)

Washington State Health Care Authority sent this bulletin at 12/08/2025 04:16 PM PST

December 8, 2025

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Pharmacy prior authorization requests for Apple Health Fee-for-Service (FFS)

Apple Health Fee-for-Service (FFS) does not have an electronic pharmacy prior authorization (PA) system and does not contract with healthcare software companies that offer automated PA solutions. If providers choose to submit PA requests to FFS utilizing a healthcare software company, this may result in delays. Healthcare software companies do not have access to the most up to date PA forms for FFS and PA requests received do not typically include all the information required to process the PA request. For information on how to submit a PA to FFS, drug coverage and billing guides, see the resources below.

Pharmacy PA Resources

How to submit a PA for FFS:

Drug coverage and billing guidelines:

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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Nondiscrimination

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.