Apple Health Preferred Drug List updates - Washington State Local Health Insurance - CHPW

Apple Health Preferred Drug List updates

The Health Care Authority (HCA) implemented the Apple Health Preferred Drug List (PDL) on January 1, 2018. All managed care plans and the fee-for-service program serving Apple Health clients use this PDL. The PDL now includes over-the-counter medications, vitamins, and many other outpatient drugs.

There are now 441 therapeutic drug classes included in the PDL. Updates are ongoing.

See which drugs are preferred and whether they require a PA:

https://www.hca.wa.gov/billers-providers-partners/programs-and-services/apple-health-preferred-drug-list-pdl.

HCA has created policies that document the coverage criteria for drug classes or individual drugs. To view the policies visit:  https://www.hca.wa.gov/billers-providers-partners/programs-and-services/apple-health-medicaid-drug-coverage-criteria

The drugs within a chosen therapeutic class are evaluated by the HCA Pharmacy and Therapeutic (P&T) Committee/Drug Utilization Review (DUR) Board. The HCA P&T Committee / DUR Board meet at least quarterly. All meetings are open to the public. You can read more about the meetings here:  https://www.hca.wa.gov/about-hca/prescription-drug-program/meetings-and-materials

Open the following pdf document to see upcoming meeting dates and current drug classes.

➔ Download Apple Health PDL Updates

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