- Opioid Dosing Guidelines
- WA Health Care Authority Washington State PDL, Prescription Assistance Program Information
- WPDL List effective April 1, 2009
- State Maximum Allowable Cost (SMAC) list effective June 1, 2009
Pharmacy Information
NEW!
Effective July 1, 2009, the Department of Social and Health
Services (DSHS) will automatically authorize lamotrigine
(Lamictal) for FDA-approved indications using Expedited
Authorization (EA) codes. Prior authorization will be
required for all off-label use. See
fact sheet. In addition, DSHS will require prior
authorization for prescriptions of Seroquel/Seroquel XR dosed
daily at 50mg or less. See
fact sheet.
Effective July 1, 2009, the
Department implemented a rate change to AWP-16. See the
attached
memo dated June 1, 2009.
On May 1, 2009, the Department implemented step therapy
for inhaled long-acting beta agonist/corticosteroid combination
drugs. See
Memo 09-11.
On April 1, 2009, the Department implemented limits
on duration of use for all Proton Pump Inhibitors
(Memo 09-08;
Fact Sheet 009-004); made changes to the Washington
Preferred Drug List (PDL); and made changes and additions to
the
Expedited Authorization (EA) List.
On March 1, 2009, the Department
developed an Antipsychotic Drug Initiative. DSHS required
authorization and a DSHS-approved second opinion for clients who
exceeded the antipsychotic drug age and dosing limits. For more
information, see
Memo 09-04.
For dates of service on and after January 1,
2009, the Department raised the maximum copayment for
Medicare Part D copayments to $6.00 per prescription for clients
who have a prescription benefit through Medicaid AND are
eligible for Medicare Part D (dual eligible clients). See
Memo 08-88.
On October 20, 2008, the Department
implemented the new ProviderOne Point-of-Sale (POS) system. See
Memo
08-55 for details. Click
here for the most recent update regarding POS
implementation.
Payer
Specification Sheet
Effective on and after 10/20/08
The Health & Recovery Services Administration (HRSA) continues Application of July 1, 2008, Preferred Drug List Until October 20, 2008. The Washington State Healthcare Authority Prescription Drug Program has announced changes to the Washington State Preferred Drug List (PDL) to be implemented on October 1, 2008. HRSA will not implement these changes to the Washington PDL on October 1, 2008. Scheduled implementation of the October Washington PDL will continue for both UMP and L & I. See Memo 08-61 for additional details.
On July 1, Medicaid clients were able to access a new stop-smoking benefit that includes counseling and prescription drugs. See Memo 08-22 titled "Prescription Drug Program: Expanded Smoking Cessation Program and Changes to the Washington PDL and List of Limitations on Certain Drugs".
Enroll in the Pharmacy Policy Listserv to receive policy updates and other important information for Medicaid enrolled pharmacies!
Tamper-resistant prescription pads became a requirement for Medicaid prescriptions April 1, 2008. Effective October 1, 2008 prescription pads must contain all three tamper resistant features.
Click here for a list of tamper-resistant prescription pad suppliers.
More information is listed on the federal Medicaid Web site at http://www.cms.hhs.gov/DeficitReductionAct/30_GovtInfo.asp
Are you a Provider? Please take a moment to participate in the DSHS Provider Survey.
Where can I find?
- Pharmacy News and Announcements Information on new drugs, Healthy Options clients that self refer, Second Opinion Network Providers list, Fair Hearings, information on transportation for clients, Medicare Part D, Preferred Drug List (PDL), Mental Health Pharmaceutical News, and Reports
- Pharmacy Prior Authorization Prior Authorization fax forms, PDL drug list, and list of limits
- Prescription Billing Current Expedited Authorization (EA) list, Prescription Drug Program Billing Instructions, HRSA Preferred Drug Lists (PDL), Numbered Memorandums
- WA Preferred Drug List (PDL) List of preferred drugs and link on how to become an endorsing prescriber
- Pharmacy Reimbursement Request to Change Reimbursement fax form, current SMAC list, AWP-50% exclusions, Federal Upper Limits and NCPDP Billing Standards
- Substance Abuse: A Provider Toolkit (NEW) Chemical Dependency Treatment, Treatment for Chronic Pain, Curb Abuse and Misuse of Medical Resources, and Dual Disorder Programs
- HRSA Criteria For Authorization of Suboxone
- Current List of Participating Drug Rebate Manufacturers (Excel spreadsheet)
- List of Drugs Requiring a 90-Day Supply
For comments or questions regarding Health and Recovery Services Administration: contact us.
