Washington's Health Care Authority uses the HCA 13-835A for fee-for-service Apple Health pharmacy authorization requests, and for reimbursement rate adjustments on prescriptions not signed dispense as written. A prescriber or pharmacy meets it when a prescription needs prior authorization or a limit exception. The form is faxed to HCA's pharmacy authorization unit, which sends a confirmation fax when it can identify the sender.
The prescriber or the pharmacy completes and types all fields, including pharmacy and prescriber NPIs, drug, NDC, quantity, days supply, directions, diagnosis and a comments section on medical necessity.
Download the current version from the source each time; forms change without notice.
Pharmacy Information Authorization
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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No. The instructions state that all fields must be typed. The form is a fillable PDF, revised April 2024, and each numbered field has instructions on the following pages, including the client ID, which is 9 numbers followed by WA as shown on the client's ID card.
HCA posts drug-specific authorization requests for certain products, such as 13-003 for botulinum toxins, 13-0064 for Crysvita and 13-885 for Cimzia. Use the specific form when one exists; the 13-835A is the general pharmacy request for other fee-for-service prescriptions.