There is no substitute for safety when prescribing medication.
Get a current list of pharmacies in the network or find out which drugs are on the formulary:
You can also read or download the:
Important: The formulary and search do not apply to Medicare Advantage Plan members. If you are a Medicare Advantage provider, see the Medicare Advantage Plan formulary.
To request a prior authorization, step therapy, nonformulary, or quantity limit override, please call ESI at 1-888-256-6132, 24 hours a day, 7 days a week, and speak to a prior authorization service specialist. This specialist will review medical information and criteria with the provider or designee regarding the need for the requested drug.
Hepatitis C Therapy
(As of January 1, 2015)
1. The Washington State HCA will be responsible for ALL pre-authorizations and approvals for therapy based on HCA clinical guidelines. HCA Policy is available here.
2. All payment processes for oral Hepatitis C therapy will be required to be billed as Fee-For-Service from the pharmacy to the Health Care Authority.
3. Express Scripts (ESI) will no longer be paying these claims on behalf of CHPW.
4. For prior authorizations for Hep C therapy filled on or after January 1, 2015, dispensing pharmacies and prescribers will need to work directly with DSHS/HCA. See HCA policy for guidance.
Medication Therapy Management
Coverage for Medication Therapy Management services is now available to Apple Health providers and members who meet certain eligibility requirements.
If you are a Medicare Advantage member, visit the Community HealthFirst website for information on Medicare HealthFirst Medication Therapy information.
- MTM Provider Credentialing Checklist
- MTM Provider and Member Requirements
- Sample MTM form (for assistance in guiding medication therapy review)
Pharmacy and Therapeutics (P&T) Committee
Our P&T Committee meets quarterly to evaluate our formulary, prior authorization requirements, and safety measures to ensure quality. Read the most recent decisions:
- March 3, 2017 P&T Decisions
- November 11, 2016 P&T Decisions
- June 17, 2016 P&T Decisions
- March 11, 2016 P&T Decisions
Be sure to read the latest Drug Recall Report for updates on medications that are recalled due to safety issues.