Formulary Changes - Washington State Local Health Insurance - CHPW
Community Health Plan of Washington Apple Health Medicaid Plan Community Health Plan of Washington Apple Health Medicaid Plan

Formulary Changes

The following formulary changes will be effective starting 7/1/22 for all CHPW Medicaid members. Please visit https://www.hca.wa.gov/billers-providers-partners/programs-and-services/apple-health-preferred-drug-list-pdl for more details.

Moving to not covered status:

ANTIFUNGALS : TOPICAL

  • Mycozyl AC cream

Moving to nonpreferred status:

ANTIBIOTICS : VAGINAL

  • Vandazole Gel 0.75%

ANTIDIABETICS : INSULIN – PRE-MIXED

  • Novolog Mix 70-30 vial

Moving to preferred status:

ANTIHYPERTENSIVES : ACE INHIBITORS

  • Quinapril tablets (5, 10, 20, 40 mg)

GASTROINTESTINAL AGENTS – ULCER DRUGS : PROTON PUMP INHIBITORS (PPI)

  • Protonix 40 mg suspension packets

GASTROINTESTINAL AGENTS : IRRITABLE BOWEL SYNDROME (IBS) AGENTS / GI MOTILITY

  • Movantik tablets (12.5 and 25 mg)

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