The following formulary changes will be effective 04/01/24 for all CHPW Apple Health (Medicaid) members. Please visit https://www.hca.wa.gov/billers-providers-partners/programs-and-services/apple-health-preferred-drug-list-pdl 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 PREFERRED status
| Medication Name | Prior Authorization Required? |
| Austedo XR (deutetrabenazine ER) | No |
List of medications moving to NONPREFERRED status
| Medication Name | Prior Authorization Required? |
| Vraylar (cariprazine) | Yes |
List of medications moving to Fee-For-Service (carve out); effective dates varied since prior update 01/01/24
| Medication Name | These medications will be managed by Washington State Health Care Authority (HCA) Fee-For-Service. To initiate a prior authorization, prescribers or pharmacies must call the HCA at 800-562-3022. |
| Zilbrysq (zilucoplan sodium) | |
| Wainua (eplontersen sodium) | |
| Casgevy (exagamglogene autotemcel) | |
| Lyfgenia (lovotibeglogene autotemcel) | |
| Rivfloza (nedosiran sodium) | |
| Fabhalta (iptacopan hcl) |
Other HCA and CHPW Clinical Policy, Formulary and Criteria Updates (see below for effective dates)
| Policy | Summary of Update |
| Tick-Borne Encephalitis Vaccine
Effective 01/01/24 |
Ticovac covered, no restrictions |
| Morphine Milligram Equivalent Conversion Factor
Effective 01/12/24 |
|
| Long Acting Insulins
Effective 01/18/24 |
Due to insulin glargine market access challenges, the HCA has added the following to be preferred with no prior authorization:
|
| New HCA drug policies
Effective 02/01/24 |
|
| Anti-Narcolepsy Updated (61.40.00-2)
Effective 02/01/24 |
|
| Vyvanse
Effective 02/16/24 |
Brand name Vyvanse may be approved for 3 months at a time through prior authorization if reason for request is due to shortage of generic lisdexamfetamine. |
| Brixadi
Effective 03/01/24 |
Brixadi moved to preferred status with no prior authorization required. Brixadi is NOT restricted to specialty pharmacy. |
| Proton Pump Inhibitor (PPI) (49.27.00-2)
Effective 03/01/24 |
For long-term use of PPI for diagnosis of Barret’s esophagus, the requirement of “corresponding pathology report showing histological confirmation of intestinal metaplasia in esophageal biopsies” has been removed. |
| Multiple Sclerosis therapy
Effective 04/01/24 |
|
| Cytokine & CAM Antagonists (66.27.00)
Effective 04/01/24 |
|
| GLP 1 Agonist (27.17.00-1)
Effective dates noted on the right |
Effective 12/20/23
Effective 04/01/24
|
| Movement Disorders
Effective 04/01/24 |
|
