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:

Search Pharmacies buttonSearch Formulary button

 

 

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.

Prior Authorization

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. We are in the process of developing our comprehensive list of drugs that require a Prior Authorization. Please see the list of drugs that require a prior authorization for:

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 Eligibility Requirements

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:

Medication Safety

Be sure to read the latest Drug Recall Report for updates on medications that are recalled due to safety issues.