The following formulary changes will be effective 4/1/23 for all CHPW Apple Health (Medicaid) members. Please visit https://www.hca.wa.gov/billers-providers-partners/programs-and-services/apple-health-preferred-drug-list-pdl for more details or call CHPW Customer Service at 1-800-440-1561 Monday through Friday from 8am to 5pm.
List of medications moving to preferred status
| Brand Name | Generic Name | Prior Authorization Status |
| Anoro Ellipta | umeclidinium/vilanterol | no prior authorization required |
| Dupixent | dupilumab | prior authorization required |
| Eucrisa | crisaborole | no prior authorization required |
| Qelbree | viloxazine | prior authorization required |
| Xiidra | lifitegrast | no prior authorization required |
List of medications moving to nonpreferred status
| Brand Name | Generic Name | Prior Authorization Status |
| Wakix | pitolisant | prior authorization required |
HCA Clinical Policy Updates and Criteria Updates
| Policy Name & Number | Summary of Update |
| Dupixent 90.27.30.20 | Updated to preferred status and indications for age updates and approval duration |
| ADHD/Anti-Narcolepsy: Non-stimulants-viloxazine (61.35.40.AA_v1) | New HCA policy. SON review required for ages 0-5 and doses that exceed 400 mg per day for ages 6-17. Max dose for adults is 600 mg/day |
| ADHD Stimulant Drugs | Stimulant use for adults will require a diagnosis of ADHD. This applies to both long and short acting stimulants. |
| Tyrosine Kinase Inhibitors 21.53.40-1 | Added Exkivity (mobocertinib), Scemblix (asciminib), Jaypirca (pirtobrutinib) to policy. Updated dosing for Lenvima (lenvatinib), Turalio (pexidartinib), Xalkori (crizotinib) and updated approval duration** |
| Antidiabetics-GLP-1 Agonists (27.17.00-1) | Added Mounjaro (tirzepatide) to policy** |
| Testosterone 23.10.00-2 | Added Kyzatrex & Tlando (testosterone undecanoate) to policy** |
| SUDs-Transmucosal Buprenorphine (65.20.00.10-3) | Expedited authorization code 85000000078 added for pharmacies to submit for non-pregnant members to receive buprenorphine while initiating a prior authorization** |
** signifies an effective date of 3/1/23
