Buprenorphine - Expedited Authorization and Emergency Fill Policy

Dental Medicaid

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Buprenorphine - Expedited Authorization and Emergency Fill Policy

Please read the following update from the HCA:

The Health Care Authority (HCA) would like to remind providers of the Washington Apple Health fee-for-service (FFS) expedited authorization (EA) criteria for buprenorphine monotherapy for pregnant clients. This EA allows pharmacies to submit a claim for a seven (7) day supply without a prior authorization. After submitting a claim with this EA, pharmacies and/or providers should request a prior authorization for further fills.

Drug Code Criteria
Seven (7) day induction of buprenorphine monotherapy for pregnant clients

In addition to the EA criteria, pharmacists also have the option to dispense an emergency fill, at the discretion of the pharmacist, for any medication to meet the immediate and/or urgent needs of the client, including prescriptions for buprenorphine monotherapy.

For clients enrolled in Apple Health managed care plan, contact the client’s plan.


HCA’s Buprenorphine Containing Products Policy
Apple Health FFS EA list
HCA’s Emergency Fill Policy

For additional questions, email: applehealthpharmacypolicy@hca.wa.gov.

Medicaid Transition to Managed Care Cancelled

The 2019 Legislature has directed the Washington State Health Care Authority (HCA) to continue to administer the dental Medicaid program through fee-for-service. The HCA may not proceed with a carved-out or carved-in managed care dental option at this time.

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Questions? Please email info@wsda.org.