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