Pharmacy
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News and updates
- Pharmacy billers 2025 Q&A sessions
- New billing information for Apple Health fee-for service (FFS)
- New BIN: 024822
- New PCN: DRWAPROD
- New Group: CAID
- Payer Specification Sheet
- Emergency Fill Policy
- Professional dispensing fee allowance for pharmacies FAQ
- Synagis 2024/2025 season
Health advisories
Unintentional overdose deaths are associated with methadone and other opioids. The Pharmacy and Therapeutics Committee (P&T) has asked the Health Care Authority (HCA) to distribute a special health advisory to pharmacists and prescribers.
Prescription drug billing, rate, authorization, and cost information
For information on billing and rates, expedited authorization (EA) codes, and the state maximum allowable cost list (SMAC), please visit the Prescription Drug Program on our provider billing guide and rates page.
Practitioners
- Agency Medical Director’s Group (AMDG) opioid prescribing guidelines/dose calculator
- Apple Health (Medicaid) Drug Coverage Criteria
- Over the counter contraception for Apple Health clients FAQ - prescribers
Pharmacies
- Request a pharmacy prior authorization
- Emergency fill policy
- Payer specification sheet
- Participating drug rebate manufacturers
- Critical Access Pharmacy List
- Over the counter contraception for Apple Health clients FAQ - pharmacies
- Apple Health Prescription Monitoring Program check for outpatient prescriptions - FAQ (updated September 16, 2021)
To request a change in fee-for-service (FFS) reimbursement
Download the Pharmacy Information Authorization form (13-835A). Fax the request to: 1-833-991-0704.
NADAC price not meeting your acquisition cost?
If the National Average Drug Acquisition Cost (NADAC) price is not meeting your acquisition cost, contact the NADAC help desk to contribute your cost information to the NADAC Retail Price Survey. Phone: 855-457-5264 Email: NADAC help desk.