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Medications Qualifying for Emergency Fill

Abilify
Absorica
Actiq
Actonel
Adapalene
Advair Diskus
Advair HFA
Advicor
Aggrenox
Alvesco
Almotriptan
Amitiza
Amnesteem
Androderm
Anzemet
Arcapta Neohaler
Arestin
ARIPiprazole
Aspirin-Dipyridamole ER Atelvia
Avodart
Axert
Azelex
Azilect

Banzel
BenzaClin
BenzaClin with Pump
Benzamycin
Benzoyl Peroxide-Erythromycin
Botox
Brintellix
Brovana
Budesonide
Buprenorphine HCl
Buprenorphine HCl-Naloxone HCl
Butorphanol Tartrate
Butrans
Byetta 10 MCG Pen
Byetta 5 MCG Pen

Calcipotriene-Betamethasone
Carbamazepine ER
Carbatrol
CeleBREX
Celecoxib
Clenia
Cialis
Claravis
Clindamycin Phos-Benzoyl Perox
Crestor
Cystagon

Darifenacin Hydrobromide ER
DDAVP
Desmopressin Acetate
Detrol LA
Exilant
Differin
Dihydroergotamine Mesylate
Duac
Dutasteride
Dysport
Dysport (Glabellar Lines)

Edarbi
Elidel
Embeda
Emend
Enablex
Epiduo
Eprosartan Mesylate
Equetro
Esomeprazole Magnesium
Eszopiclone
Exalgo

Famciclovir
Famvir
Fanapt
Fanapt Titration Pack
Femara
FentaNYL Citrate
Flector
Flovent
Foradil Aerolizer
Fosamax Plus D
Frova
Frovatriptan Succinate

Griseofulvin Microsize
GuanFACINE HCl ER

HYDROmorphone HCl ER

Intuniv
Invega
Invokana
Itraconazole

Januvia

Kadian

Latuda
Lexapro
Linezolid
Livalo
Lovaza
Lumigan
Lunesta
Lyrica

Migranal
Modafinil
Mometasone Furoate
Morphine Sulfate ER
Mycobutin
Myorisan
Myrbetriq

Nasonex
Neuac
Nucynta
Nucynta ER
Nuvigil

Oleptro
Omega-3-acid Ethyl Esters
Onfi
Opana ER
OxyCODONE HCl ER
OxyCONTIN
Oxymorphone HCl ER

Paliperidone ER
PARoxetine HCl
PARoxetine HCl ER
Paxil
Paxil CR
Plexion SCT
Potiga
Pristiq
Provigil
Pulmicort
Pulmicort Flexhaler

Relpax
Requip XL
Retin-A Micro
Retin-A Micro Pump
Revatio
Rhinocort Allergy
Rhinocort Aqua
Risedronate Sodium
RisperDAL
RisperDAL Consta
RisperDAL M-TAB
RisperiDONE
RisperiDONE M-TAB
Ropinirole HCL ER
Rosuvastatin Calcium
Rozerem

Saphris
Savella
Savella Titration Pack
SEROquel XR
Simcor
Soltamox
Sotret
Sporanox
Sporanox Pulsepak
Strattera
Suboxone
Subutex
Sulfacetaminde Sodium Sulfur
Sumadan Wash
Suphera
Symbicort
SymlinPen 120
SymlinPen 60

Taclonex
Tegretol XR
Teveten
Tolterodine
Tartrate ER
Topisulf
Toviaz
Tracleer
Tretinoin Microsphere
Tretinoin Microsphere Pump
Trintellix
Truvada

Uloric

Valcyte
ValGANciclovir HCl
Valtrex
Veltin
VESIcare
Victoza
Vimpat
Virti-Sulf
Vytorin

Xeomin
Xifaxan
Xopenex HFA

Zenatane
Zetia
Zohydro ER
Zolmitriptan
Zomig
Zomig ZMT
Zyvox

Pursuant to section WAC 284-170-470:

a) The authorized amount of the emergency fill will be no more than the prescribed amount up to a seven day supply or the minimum packaging size available at the time the emergency fill is dispensed

b) An emergency fill medication does not necessarily constitute a covered health service. Determination as to whether this is a covered health service under the patient benefit will be made as part of the prior authorization processsing.