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.
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.
Resources:
• HCA’s Buprenorphine Containing Products Policy
• Apple Health FFS EA list
• HCA’s Emergency Fill Policy
For additional questions, email: applehealthpharmacypolicy@hca.wa.gov.
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 |
| Buprenorphine |
077 |
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.
Resources:
• HCA’s Buprenorphine Containing Products Policy
• Apple Health FFS EA list
• HCA’s Emergency Fill Policy
For additional questions, email: applehealthpharmacypolicy@hca.wa.gov.
