Apple Health Expansion Pharmacy Benefits - Washington State Local Health Insurance - CHPW
Community Health Plan of Washington Apple Health Medicaid Plan Community Health Plan of Washington Apple Health Medicaid Plan

Apple Health Expansion Pharmacy Benefits

Apple Health Expansion will provide health care coverage to uninsured adults who do not meet the immigration requirements for federal assistance beginning 7/1/24.

Pharmacy benefits are included in the coverage. Pharmacy benefits will mirror the Apple Health Preferred Drug List (AHPDL) used for Apple Health (Medicaid) members with some exceptions.

A complete list of AHPDL drug classes that must be billed Fee-For-Service (FFS) can be found below. To bill FFS and request coverage, please call the HCA at 800-562-3022.

Please visit https://www.hca.wa.gov/billers-providers-partners/program-information-providers/apple-health-preferred-drug-list-pdl for more details on the AHPDL or call CHPW Customer Service at 1-800-440-1561 Monday through Friday from 8am to 5pm.

List of AHPDL Drug Classes that must be filled Fee-For-Service (FFS)

ANTICONVULSANTS

ANTICONVULSANTS: NEUROACTIVE STEROID- GABA MODULATOR

ANTIDEMENTIA AGENTS

ANTIDEMENTIA AGENTS: ANTI-AMYLOID ANTIBODIES

ANTIDIABETICS

ANTIDIABETICS: ANTI-CD3 ANTIBODIES
ANTIDIABETICS: CELLULAR THERAPY

ANTIHEMOPHILIC PRODUCTS

ANTIHEMOPHILIC PRODUCTS: GENE THERAPY AGENTS

ANTIHYPERLIPIDEMICS

ANTIHYPERLIPIDEMICS: ANGIOPOIETIN-LIKE PROTEIN INHIBITORS

ANTIPARASITICS

ANTIPARASITICS: FOLIC ACID ANTAGONISTS

ANTIVIRALS

ANTIVIRALS: COVID-19 – ORAL
ANTIVIRALS: HEPATITIS C AGENTS – DIRECT ACTING ANTIVIRALS
ANTIVIRALS: HIV – INJECTABLE
ANTIVIRALS: HIV – MONOCOLONAL ANTIBODIES
ANTIVIRALS: HIV – ORAL

CARDIOVASCULAR AGENTS

CARDIOVASCULAR AGENTS : TRANSTHYRETIN STABILIZERS

DERMATOLOGICS

DERMATOLOGICS: GENE THERAPY
DERMATOLOGICS: MELANOCORTIN RECEPTOR AGONISTS (UV PROTECTIVE)

ENDOCRINE AND METABOLIC AGENTS

ENDOCRINE AND METABOLIC AGENTS: ACID SPHINGOMYELINASE DEFICIENCY AGENTS
ENDOCRINE AND METABOLIC AGENTS: ADENOSINE DEAMINASE SCID TREATMENT AGENTS – INJECTABLE
ENDOCRINE AND METABOLIC AGENTS: ADRENAL STEROID INHIBITORS
ENDOCRINE AND METABOLIC AGENTS: ALPHA MANNOSIDOSIS AGENTS
ENDOCRINE AND METABOLIC AGENTS: CORTISOL SYNTHESIS INHIBITORS
ENDOCRINE AND METABOLIC AGENTS: FABRY DISEASE AGENTS – INJECTABLE
ENDOCRINE AND METABOLIC AGENTS: FABRY DISEASE AGENTS – ORAL
ENDOCRINE AND METABOLIC AGENTS: GAA DEFICIENCY AGENTS
ENDOCRINE AND METABOLIC AGENTS: HEREDITARY TYROSINEMIA TYPE 1 (HT-1) AGENTS – ORAL
ENDOCRINE AND METABOLIC AGENTS: HYPERAMMONEMIA AGENTS – ORAL
ENDOCRINE AND METABOLIC AGENTS: HYPOPHOSPHATASIA AGENTS – INJECTABLE
ENDOCRINE AND METABOLIC AGENTS: INSULIN-LIKE GROWTH FACTORS – INTRAVENOUS
ENDOCRINE AND METABOLIC AGENTS: LEPTIN ANALOGUES
ENDOCRINE AND METABOLIC AGENTS: LYSOSMAL ACID LIPASE DEFICIENCY AGENTS
ENDOCRINE AND METABOLIC AGENTS: MOLYBDENUM COFACTOR DEFICIENCY (MOCD) AGENTS
ENDOCRINE AND METABOLIC AGENTS: MUCOPOLYSACCHARIDOSIS AGENTS
ENDOCRINE AND METABOLIC AGENTS: NATRIURETIC PEPTIDES
ENDOCRINE AND METABOLIC AGENTS: PHENYLKETONURIA (PKU) AGENTS – INJECTABLE
ENDOCRINE AND METABOLIC AGENTS: PHENYLKETONURIA (PKU) AGENTS – ORAL
ENDOCRINE AND METABOLIC AGENTS: TRIPEPTIDYL PEPTIDASE 1 DEFICIENCY AGENTS
ENDOCRINE AND METABOLIC AGENTS: UREA CYCLE DISORDER AGENTS – ORAL
ENDOCRINE AND METABOLIC AGENTS: X-LINKED HYPOPHOSPHATEMIA (XLH) AGENTS
NUTRIENTS: LIPIDS

GASTROINTESTINAL AGENTS

GASTROINTESTINAL AGENTS: ILEAL BILE ACID TRANSPORTER INHIBITORS
GASTROINTESTINAL AGENTS: SHORT BOWEL SYNDROME

GENITOURINARY AGENTS - MISC

GENITOURINARY AGENTS – MISC: HYPEROXALURIA AGENTS

GENITOURINARY AGENTS

GENITOURINARY AGENTS – MISC: HYPEROXALURIA AGENTS
GENITOURINARY AGENTS: CYSTINOSIS AGENTS
GENITOURINARY AGENTS: IGA NEPHROPATHY AGENTS

GOUT AGENTS

GOUT AGENTS: PEGYLATED URIC ACID ENZYMES

HEMATOLOGICAL AGENTS - MISC

HEMATOLOGICAL AGENTS – MISC: AMINOLEVULINATE SYNTHASE 1-DIRECTED SIRNA
HEMATOLOGICAL AGENTS – MISC: ANTIHEMOPHILIC PRODUCTS
HEMATOLOGICAL AGENTS – MISC: ANTIHEMOPHILIC PRODUCTS
HEMATOLOGICAL AGENTS – MISC: COMPLIMENT INHIBITORS
HEMATOLOGICAL AGENTS – MISC: COMPLIMENT INHIBITORS – INJECTABLE

HEMATOLOGICAL AGENTS

HEMATOLOGICAL AGENTS: ANTI-VON WILLEBRAND FACTOR AGENTS
HEMATOLOGICAL AGENTS: HEREDITARY ANGIOEDEMA AGENTS
HEMATOLOGICAL AGENTS: PLASMA PROTEINS
HEMATOLOGICAL AGENTS: PYRUVATE KINASE ACTIVATORS
HEMATOLOGICAL AGENTS: THROMBOTIC THROMBOCYTOPENIA PURPURA AGENTS

HEMATOPOEITIC AGENTS

HEMATOPOEITIC AGENTS: AUTOLOGOUS CELLULAR GENE THERAPY
HEMATOPOIETIC AGENTS: CXCR4 RECEPTOR ANTAGONISTS
HEMATOPOIETIC AGENTS: ERYTHROID MATURATION AGENTS
HEMATOPOIETIC AGENTS: GAUCHER DISEASE
HEMATOPOIETIC AGENTS: SICKLE CELL ANEMIA – SELECTIN BLOCKERS
HEMATOPOIETIC AGENTS: SICKLE CELL ANEMIA AGENTS – INJECTABLE

HIV

HIV: ANTIVIRALS – INJECTABLE*
HIV: ANTIVIRALS – ORAL*
HIV: MONOCLONAL ANTIBODIES – INJECTABLE*

IMMUNOSUPPRESSIVE AGENTS

IMMUNOSUPPRESSIVE AGENTS: CYCLOSPORINE ANALOGS – INJECTABLE
IMMUNOSUPPRESSIVE AGENTS: CYCLOSPORINE ANALOGS – ORAL
IMMUNOSUPPRESSIVE AGENTS: IMMUNE GLOBULIN IMMUNOSUPPRESSANTS
IMMUNOSUPPRESSIVE AGENTS: INOSINE MONOPHOSPHATE DEHYDROGENASE INHIBITORS – INJECTABLE
IMMUNOSUPPRESSIVE AGENTS: INOSINE MONOPHOSPHATE DEHYDROGENASE INHIBITORS – ORAL
IMMUNOSUPPRESSIVE AGENTS: MACROLIDE IMMUNOSUPPRESSANTS
IMMUNOSUPPRESSIVE AGENTS: MONOCLONAL ANTIBODIES
IMMUNOSUPPRESSIVE AGENTS: ROCK INHIBITORS
IMMUNOSUPPRESSIVE AGENTS: SELECTIVE T-CELL COSTIMULATION BLOCKERS

MISCELLANEOUS THERAPEUTIC CLASSES

MISCELLANEOUS THERAPEUTIC CLASSES: ALLOGENEIC TISSUE*
MISCELLANEOUS THERAPEUTIC CLASSES: NEONATAL FC RECEPTOR ANTAGONIST
MISCELLANEOUS THERAPEUTIC CLASSES: PHOSPHOINOSITIDE 3-KINASE AGENTS
MISCELLANEOUS THERAPEUTIC CLASSES: PIK3CA-RELATED AGENTS
MISCELLANEOUS THERAPEUTIC CLASSES: PROGERIA TREATMENT AGENTS

MUSCULOSKELETAL THERAPY AGENTS

MUSCULOSKELETAL THERAPY AGENTS: FIBRODYSPLASIA AGENTS

NEUROLOGICAL AGENTS

NEUROLOGICAL AGENTS: ANOREXIANTS / ANTI-OBESITY – GLP-1 RECEPTOR AGONISTS
NEUROLOGICAL AGENTS: AUTOLOGOUS CELLULAR GENE THERAPY AGENTS
NEUROLOGICAL AGENTS: METACHROMATIC LEUKODYSTROPHY AGENTS
NEUROLOGICAL AGENTS: TRANSTHYRETIN AMYLOIDOSIS AGENTS

NEUROMUSCULAR AGENTS

NEUROMUSCULAR AGENTS: ALS AGENTS – MISC
NEUROMUSCULAR AGENTS: ALS AGENTS – MISC
NEUROMUSCULAR AGENTS: ALS AGENTS – MISC
NEUROMUSCULAR AGENTS: FREIDRICHS ATAXIA AGENTS
NEUROMUSCULAR AGENTS: MUSCULAR DYSTROPHY AGENTS
NEUROMUSCULAR AGENTS: POTASSIUM CHANNEL BLOCKERS
NEUROMUSCULAR AGENTS: RETT SYNDROME AGENTS
NEUROMUSCULAR AGENTS: SPINAL MUSCULAR ATROPHY – GENE THERAPY AGENTS
NEUROMUSCULAR AGENTS: SPINAL MUSCULAR ATROPHY AGENTS – ANTISENSE OLIGONUCLEOTIDES

NUTRIENTS

NUTRIENTS: LIPIDS

ONCOLOGY AGENTS

ONCOLOGY AGENTS: ALLOGENIC CELLULAR IMMUNOTHERAPY*
ONCOLOGY AGENTS: ANDROGEN BIOSYNTHESIS INHIBITORS – ORAL*
ONCOLOGY AGENTS: ANTIADRENALS – ORAL*
ONCOLOGY AGENTS: ANTIANDROGENS – ORAL*
ONCOLOGY AGENTS: ANTIESTROGENS – ORAL*
ONCOLOGY AGENTS: ANTIMETABOLITES – ORAL*
ONCOLOGY AGENTS: ANTINEOPLASTICS – MISC COMBINATIONS – ORAL*
ONCOLOGY AGENTS: AROMATASE INHIBITORS – ORAL*
ONCOLOGY AGENTS: AUTOLOGOUS CELLULAR IMMUNOTHERAPY*
ONCOLOGY AGENTS: AUTOLOGOUS CELLULAR IMMUNOTHERAPY (CAR-T)*
ONCOLOGY AGENTS: BCL-2 INHIBITORS – ORAL*
ONCOLOGY AGENTS: BRAF KINASE INHIBITORS – ORAL*
ONCOLOGY AGENTS: CYCLIN DEPENDENT KINASES (CDK) INHIBITORS – ORAL*
ONCOLOGY AGENTS: ESTROGENS-ANTINEOPLASTIC – ORAL*
ONCOLOGY AGENTS: FGFR KINASE INHIBITORS – ORAL*
ONCOLOGY AGENTS: GAMMA SECRETASE INHIBITORS*
ONCOLOGY AGENTS: GENE THERAPIES*
ONCOLOGY AGENTS: GONADOTROPIN-RELEASING HORMONE (GNRH) RECEPTOR ANTAGONISTS – ORAL*
ONCOLOGY AGENTS: HEDGEHOG PATHWAY INHIBITORS – ORAL*
ONCOLOGY AGENTS: HIF-2-ALPHA INHIBITORS*
ONCOLOGY AGENTS: HISTONE DEACETYLASE INHIBITORS – ORAL*
ONCOLOGY AGENTS: IMMUNE MODULATORS*
ONCOLOGY AGENTS: INTERFERONS*
ONCOLOGY AGENTS: ISOCITRATE DEHYDROGENASE-1 (IDH1) INHIBITORS – ORAL*
ONCOLOGY AGENTS: ISOCITRATE DEHYDROGENASE-2 (IDH2) INHIBITORS – ORAL*
ONCOLOGY AGENTS: JANUS ASSOCIATED KINASE (JAK) INHIBITORS – ORAL*
ONCOLOGY AGENTS: KRAS INHIBITORS*
ONCOLOGY AGENTS: MEK INHIBITORS – ORAL*
ONCOLOGY AGENTS: METHYLTRANSFERASE INHIBITORS*
ONCOLOGY AGENTS: MITOTIC INHIBITORS – ORAL*
ONCOLOGY AGENTS: MULTIKINASE INHIBITORS – ORAL*
ONCOLOGY AGENTS: NITROSOUREAS – ORAL*
ONCOLOGY AGENTS: ORNITHINE DECARBOXYLASE INHIBITORS*
ONCOLOGY AGENTS: PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) INHIBITORS – ORAL*
ONCOLOGY AGENTS: POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS – ORAL*
ONCOLOGY AGENTS: PROTEASOME INHIBITORS – ORAL*
ONCOLOGY AGENTS: RADIOPHARMACEUTICALS*
ONCOLOGY AGENTS: RETINOIDS – ORAL*
ONCOLOGY AGENTS: SELECTIVE RETINOID X RECEPTOR AGONISTS – ORAL*
ONCOLOGY AGENTS: TOPOISOMERASE INHIBITORS – ORAL*
ONCOLOGY AGENTS: TROPOMYOSIN RECEPTOR KINASE INHIBITORS – ORAL*
ONCOLOGY AGENTS: TYROSINE KINASE INHIBITORS – ORAL*
ONCOLOGY AGENTS: XPO1 INHIBITORS – ORAL*

OPHTHALMIC AGENTS

OPHTHALMIC AGENTS: GENE THERAPY
OPHTHALMIC AGENTS: NERVE GROWTH FACTORS

RESPIRATORY AGENTS

RESPIRATORY AGENTS: CYSTIC FIBROSIS AGENTS*
RESPIRATORY AGENTS: CYSTIC FIBROSIS AGENTS – CFTR POTENTIATORS*

*Indicates this AHPDL class is a new carve out from Apple Health

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