Partial federal government shutdown
HCA does not anticipate any immediate impacts to our services or disruption to provider payments at this time. We will continue to monitor the situation and share updates if anything changes.
Pharmacy services
Find answers to your questions about Medicaid pharmacy and prescription drugs for Washington Apple Health (Medicaid) coverage.
Learn about your prescription drug benefits
- Does Apple Health pay for drugs?
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Yes. Apple Health (Medicaid) pays for drugs that are preferred on the Apple Health Preferred Drug List.
- What is a preferred drug list?
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A preferred drug list (PDL) is a list of drugs that Apple Health will pay for, usually without prior authorization. These drugs work well for patients and they are cost effective. A committee of physicians and pharmacists reviews and selects the preferred drugs.
- How do I know if my drug is preferred?
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Check the list of preferred drugs to see if your drug is preferred. If you can't find the drug you are looking for, contact your health plan for more information.
- How do I get a nonpreferred drug?
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Drugs are listed in groups called drug classes. Drug classes are made up of drugs that treat similar conditions. You must have tried and failed, or be intolerant to, at least two preferred drugs within the drug class, unless there is a reason you cannot or only one drug is preferred. The prescriber of your drug or your pharmacy will need to contact your health plan with this information.
- What if my drug requires prior authorization?
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Some drugs may require prior authorization (PA). These drugs are listed as PA Required in the PA Status column of the Apple Health PDL. The prescriber of your drug or your pharmacy may request a PA. This usually means your prescriber will need to send more information to your health plan before you can get the drug. You will be notified by your health plan if the drug is not approved.
- What do I do if my drug is noncovered?
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For noncovered drugs, your prescriber must request an Exception to the Rule (ETR) through your health plan.
- How does my prescriber or pharmacy contact my health plan to get my drug covered?
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To request a nonpreferred drug, PA, or ETR:
- For clients with an Apple Health managed care plan, your provider should contact your health plan.
- For clients with Apple Health fee-for-service, your provider can request through pharmacy prior authorization services.
- Does Apple Health pay for over the counter (OTC) products?
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Yes, Apple Health pays for OTC products that are preferred on the Apple Health Preferred Drug List, including OTC birth control. See the FAQ to learn more about OTC birth control and get a list of which products are covered.
Apple Health also covers COVID-19 at-home tests.
- Do I have to pay to get prescriptions filled?
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No. As an Apple Health client, you do not have to pay for covered drugs prescribed by your provider. In most situations, your provider cannot ask you to pay for any services, including drugs.
Find a pharmacy
- Which pharmacy or drug store should I use?
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Your health plan will give you information about which pharmacies and drug stores to use. Most health plans have a tool online to help find a provider who accepts Apple Health clients.
Medicare Part D Prescription Drug Program
Learn how to get Medicare prescription drug coverage through adding a Medicare Prescription Drug Plan (Part D). Anyone who has Medicare can get Medicare prescription drug coverage. Apply online for Medicare benefits.