The Health Care Authority (HCA) is requiring a new prescription monitoring program (PMP) check requirement for outpatient prescribing and dispensing of controlled substances to Apple Health patients beginning Oct. 1, 2021. Under new WAC 182-530-1080, prescribers must conduct a PMP check for controlled substances prescribed to Apple Health patients in an outpatient context. In addition, dispensing pharmacists must conduct a PMP check for controlled substances prescribed to Apple Health patients before dispensing from an outpatient pharmacy.
In preparation for the effective date, HCA issued a frequently asked questions document with information regarding the rule’s applicability. According to the document, the PMP review is required for clients enrolled in an Apple Health Managed Care plan or fee-for-service (FFS) program. This includes dual-eligible clients (those with Medicare and Medicaid) and clients with third-party-liability (TPL) where Apple Health is the secondary payer.
The PMP review is also not required for clients receiving hospice or palliative care; or treatment for cancer, are a resident of a long-term care facility, or are a resident of a facility for which frequently abused drugs are dispensed through a contract with a single pharmacy. Click here to read HCA’s FAQ document. Click here to read WSHA’s bulletin on the new PMP check requirement. (David Streeter)