The following formulary changes will be effective 08/01/24 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 |
| Nexiclon XR 0.17mg |
| Clonidine ER 0.17mg |
List of medications moving to NON-COVERED status
| Medication Name |
| Ferrous sulfate 300mg/5mL |
| Iron PS Complex/B12/Folic Acid 150-25-1 |
List of medications moving to COVERED status
| Medication Name |
| Methyldopate 250mg/5mL |
List of medications requiring PRIOR AUTHORIZATION (PA)
| Medication Name |
| Nexiclon XR 0.17mg |
| Clonidine ER 0.17mg |
| Diazepam vial, cartridge, and syringe |
| Lorazepam vial and cartridge |
| Methyldopate 250mg/5mL |
Other HCA and CHPW Clinical Policy, Formulary and Criteria Updates (see table for effective dates)
| Policy | Summary of Update |
| Health Care Authority (HCA) Fill Limit Implementation
Effective 08/01/24 |
Certain medications will be restricted to a maximum of two (2) fills within a thirty-day period. Claims exceeding this limit can be overridden at point-of-sale using Prior Authorization Type = 08 and entering 8888 for the Prior Authorization Number if one of the following reasons applies:
If the reject is not overridden by the pharmacy, prior authorization will be required. Prior authorization requests should be submitted via Express Scripts. Providers may use CoverMyMeds or call 1-844-605-8168 to speak with a prior authorization specialist. Impacted drug classes include calcitonin gene-related peptide receptor antagonists (CGRP), benzodiazepines, ophthalmic immunomodulators, oral iron replacement therapy, antihypertensive antiadrenergics, asthma/COPD inhaled corticosteroid combinations, PCSK-9 inhibitors, and pulmonary fibrosing agents. For specifics, please refer to CHPW Online Formulary. |
| New Health Care Authority (HCA) Policies
Effective 08/01/24 |
Androgen Biosynthesis Inhibitors – Abiraterone (21.40.60-1)
Endocrine and Metabolic Agents: Teprotumumab (Tepezza) (30.19.20.AA-1)
|
| Updated Health Care Authority (HCA) Policies
Effective 08/01/24 |
Antiasthmatic Monoclonal Antibodies – Anti-IgE Antibodies (44.60.30.AA-3)
|
| Medications Moving to Fee-For-Service (FFS) [Carve out] Updates
See right for effective dates |
Effective 07/16/24
Effective 07/24/24
|
