Posted on June 15th, 2026 in
Bulletin Board
by CHPW Admin
The following changes will be effective 07/01/26 for all CHPW Apple Health (Medicaid) members. Please visit Health Care Authority (HCA) website or CHPW Online Formulary 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 PREFERED status
| Medication name |
| Qulipta |
Nurtec ODT |
Omeprazole/Sod Bicarb caps
(20-1100 mg) |
| Glatiramer |
Ozempic Pen |
Prucalopride |
| Gvoke |
Accu-Chek Guide (CHPW specific) |
|
List of medications moving to NON-PREFERED status
| Medication name |
| Farxiga |
Copaxone |
Xigduo XR |
| Movantik |
Tobramycin Ampule 300 mg/4mL |
Granix (syringe) |
Other HCA and CHPW Clinical Policy, Formulary and Criteria Updates (see table for effective dates)
| Policy |
Summary of Update |
| Retired HCA policies
Effective 04/01/26 |
82.40.10 Hematopoietic Agents – Erythropoiesis Stimulating Agents (ESAs)
- Retacrit, Aranesp, Mircera, Epogen, Procrit
- Pharmacy preferred products no longer require prior authorization
|
| Retired HCA policies
Effective 06/12/26 |
90.78.40 Topical Immunosuppressives – Calcineuring Inhibitors
- Tacrolimus ointment, Pimecrolimus, Elidel
- Pharmacy preferred products (tacrolimus ointment) no longer require prior authorization
|
| Updated HCA policies
Effective 06/01/26 |
62.38.00.AA Movement Disorger Agents: Velbazine
- Removed requirement to be prescribed by or in consultation with a neurologist or psychiatrist.
- Added requirement to be prescribed by or in consultation with a provider who specializes in treating serious mental illness
27.17.00-4 Antidiabetics – GLP 1 Agonists
- Added pediatric age and dosing for Mounjaro
- 10 years and older for Type 2 Diabetes Mellitus up to 10 mg
99.39.20-2 Immune Modulators – Thalidomide Analogs
- Thalomid: reduced the quantity limitation from 500 mg daily to 400 mg daily
|
| Updated HCA policies
Effective 07/01/26 |
27.17.00-5 Antidiabetics – GLP 1 Agonists
- Ozempic Pen
- Removed indication: T2DM with established CVD or multiple CV risk factors who are at risk for major adverse CV events
- Removed indication: chronic kidney disease, to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in patients with T2DM
- Removed indication: T2DM with moderate to severe noncirrhotic metabolic dysfunction associated steatohepatitis
- Indication for T2DM: removed requirement for trial/failure with metformin and liraglutide
- Non-preferred products
- Modified the requirement: failure to achieve HbA1c of <7% with liraglutide for 90 continuous days at maximum or highest tolerated dose
- Updated liraglutide requirement to: two preferred GLP-1 Agonist products for 90 continuous days at maximum or highest tolerated dose
|
| Medications that moved to Fee-For-Service (FFS), Carve out Updates
since 04/01/26 |
- Avlayah
- Foundayo
- Kygevvi
- Wegovy HD
- Hepcludex
Note: Updated list of carve outs can always be found at Health Care Authority (HCA) website |
