Your prescription benefit with CHPW Apple Health (Medicaid) is built to support your health. But we know managing medications, health insurance, and pharmacies can be complicated. As your health plan, we want to make it as easy as possible for you to access the care and medications you need so you can feel your best.
This article is your step-by-step guide to filling prescriptions with your health plan.
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Find an in-network pharmacy near you
When you have Apple Health, health insurance, your cost is $0* for covered prescription medications when you get them from an in-network pharmacy. We offer a large network of pharmacies, including inside many of our in-network Community Health Centers (CHC) or health clinics.
When your doctor prescribes medication, they will ask you which pharmacy you want to get it from. They likely will not know which pharmacies are in your plan’s network.
To get the most out of your plan benefits, choose an in-network pharmacy that is close to where you live. Write down the name, and the street it is on, and give the information to your doctor or health clinic.
Search local in-network pharmacies online using the pharmacy search tool on Express Scripts or view our Pharmacy Directory, an A-Z list of pharmacy providers sorted by county.
For long-term medications, you may have the option to set up home-delivery through your Community Health Center pharmacy or our pharmacy partner, Express Scripts.
*Must be eligible and enrolled in Apple Health (Medicaid). The medication must be listed in the current Apple Health Preferred Drug List (Formulary), meet medical necessity rules, and get prior authorization or pre-approval if required.
I have a complex chronic condition and need a specialty drug, but my pharmacy can’t fill it.
Some medications need to be handled with special care. Contact your CHC Pharmacy or use our in-network Specialty Pharmacy, Accredo Specialty Pharmacy.
Check if your medication is covered
Picking up or ordering your medication online should be simple, without surprise issues or costs. To keep things easy, before you fill a prescription or request one, you can check if the medication is covered.
There are a few ways to do it:
- Search our Preferred Drug List (Formulary). In the search tool, read your options carefully. To search for a specific drug by name, you only need to enter the first three letters. The generic version will show too.
- View the A-Z List of the Preferred Drug List (Formulary) from our Prescription Coverage webpage.
- Talk to a member of our Customer Service Team by calling 1-800-440-1561 (TTY: 711) Monday through Friday, 8 a.m. to 5 p.m. or email [email protected].
The medication I need is not in the Preferred Drug List (Formulary), or it is there, but needs Prior Authorization. What should I do?
Don’t worry, we may just need more information before we can approve to pay for it. Your provider may also be able to prescribe another, similar medication that is covered by your plan.
Talk to your doctor about requesting a Formulary Exception or Prior Authorization. Or ask them if there are other similar medications they could prescribe.
Get your medication: New fills, transfers, and refills
Here’s what to do to get the medication your doctor may prescribe to you based on your situation:
Filling a new prescription
- Find an in-network pharmacy, make note of the name and the address.
- Give your provider or clinic the pharmacy’s information. When a medication is prescribed to you, your provider will send it to this pharmacy to fill it.
- Often times, the pharmacy will call or text you when your prescription is ready to be picked up.
If you do not hear from your pharmacy right away, call them to check if your prescription is covered and that they have it available at their location. - Pick up your prescription. Bring your CHPW Member ID and ProviderOne ID cards with you.
New to CHPW and transferring your prescription (Rx)
Check if your current pharmacy is in-network by looking it up online at Express Scripts or in our Pharmacy Directory. Also confirm the medication is covered under your new health plan.
Pharmacy not in-network:
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Pharmacy is in-network:
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Refilling a prescription
- Visit or call your in-network pharmacy or CHC pharmacy.
- Ask the pharmacist for a refill. If you request it in-person, you may have to wait while they fill it.
If your prescription is out of refills, the pharmacy can contact the doctor who prescribed it.
- When you go to pick up your prescription, bring your CHPW Member ID card and ProviderOne ID
Why does my medication look different or have a different name, for the same prescription?
If you notice a change, ask your pharmacist to double check it. It could be because a different company made it, or it’s a generic version. So, the pills may look different, and the name may change, but the quality and effectiveness stays the same.
Order refills online with Express Scripts
To help you get the medications you need when you need them, we manage your prescription benefit with the help of our partner Express Scripts.
If you take a medication routinely, registering for an online account with Express Scripts might help with managing your prescriptions. With an account, you can:
- Set up delivery* for ongoing prescriptions.
- Order 90 day* refills or track prescriptions.
- Check the status of a prior authorization (coverage review).
To get started, register on Express Script’s website.
*Long‑term medications qualify for 90‑day refills and delivery based on the current Apple Health Preferred Drug List and rules set by Express Scripts as the pharmacy benefit manager. These rules can change at any time.
Support and resources from CHPW
Remember, our team at CHPW is here to support your whole health. That includes online resources, search tools, and a team of people ready to talk with you and answer your questions.
Online, find more information about your plan, prescriptions, and managing medication here:
- View benefit details and frequently asked questions: CHPW Apple Health Prescription Coverage.
- Get tips to help you stay on track with your medication on our blog site, CHPW Connections, in this article, Be Well: Managing your medicine made easier.
- Get your questions answered about managing prescriptions online with Express Scripts.
Person-to-person, if you need help getting care, scheduling an appointment, checking if a medication is covered, or finding a pharmacy, call us at 1-800-440-1561 (TTY: 711) Monday through Friday, 8 a.m. to 5 p.m. or email [email protected].
