30-Day Prerelease Expedited Authorization List


 

Provider Alert

 

Dear Provider,

Effective for claims with dates of service on and after March 15, 2015, Washington Apple Health (Medicaid), administered by the Health Care Authority, will update the Expedited Authorization (EA) list as follows:

Drug

Code

Criteria

Humira

085

Treatment of ulcerative colitis   when prescribed by a gastroenterologist in those patients who have tried and   failed conventional therapy. Maximum maintenance dose is 5mg/kg given every 8   weeks after the induction regimen of 5mg/kg given at week 2 and week 6 of   therapy.

Ramipril

020

Removed

Remicade

046

Removed

Lamisil

 

Length of approval has shortened   from 12 months to 12 weeks.

Terbinafine

 

Length of approval has shortened   from 12 months to 12 weeks.

For more details, see the agency’s Expedited Authorization (EA) list.

Thank you.

 

Provider Publications Team
Washington Apple Health
Health Care Authority