Prescription coverage that works for you.

We want to make sure you have access to the medicine you need to get healthy and stay healthy. 

Community Health Plan of Washington partners with Express Scripts to give you access to a large network of pharmacies and a wide range of covered prescriptions. 

Go to Express Scripts to log in or create an account. An account will help you manage your prescriptions, search for pharmacies, and learn more about your medicine.

What we cover

The drugs we cover are listed in our formulary. The drugs are chosen by a Pharmacy and Therapeutics Committee, which is made up of local providers and pharmacists. Community Health Plan of Washington and the Washington State Health Care Authority decide which drugs to cover based on medical studies and research and the needs of members. All of the drugs in our formulary are FDA approved

Search our formulary or download the PDF

To request a hardcopy of the formulary be sent to you in the mail free of charge, please call Customer Service at 1-800-440-1561 (TTY Relay: Dial 7-1-1), from 8 a.m. to 5 p.m., Monday through Friday.

This formulary is for Medicaid members. If you are looking for the Medicare Advantage Plan formularies, click here.

You will need Adobe Acrobat to read the PDFs. Download it for free.

Get a larger supply of select medications

CHPW members can get a 90-day supply of select generic oral medication for hypertension, diabetes, heart failure, and hyperlipidemia, as well as generic antidepressants and antipsychotics. We also offer a 60-day supply of select asthma medication. Larger supplies of prescriptions are only available through Community Health Center pharmacies and select network pharmacies. Click below to see the full list of medication available for larger fills.

90 Day Fill List

60 Day Fill List

Checking for prior authorization

Some drugs require prior authorization, which means Community Health Plan of Washington has to review and approve coverage before we can help you pay for them. You can check whether your medicine needs prior authorization or has any coverage restrictions by calling Customer Service or checking our formulary.

Your provider is in charge of submitting prior authorization requests for your medication. 

Dealing with uncovered prescriptions

If you need medicine that isn’t listed on our formulary, you can request a coverage determination review through Customer Service.

If your coverage is denied by Express Scripts, you can appeal the decision with Community Health Plan of Washington. Read about how to appeal or file a grievance.

If you paid full price for a prescription at a retail pharmacy, you can ask for a reimbursement. Check the formulary to make sure there were no restrictions on your medication before you ask to be reimbursed. Fill out a reimbursement form and either fax or mail it to Express Scripts. 

Find a Pharmacy

We have an extensive network of pharmacies across Washington, Oregon, Idaho, and Montana, and many of our Community Health Centers have their own pharmacies. To find the pharmacy closest to you, you can:

Be sure to bring your Community Health Plan of Washington ID card when you pick up your prescription. If you don’t have your card, you can log in to your myCHPW account to view, download, and print a copy of it.

Some complex or chronic illnesses need specialty drugs that require a higher level of service or care. Our specialty drugs are covered when they are dispensed through Accredo Specialty Pharmacy or participating Community Health Center pharmacies. Check our formulary for your specialty drug and ask your local Community Health Center if their pharmacy supplies your medication.

Find your local Community Health Center.

If you’re traveling outside of our coverage area, please contact us. Usually, prescriptions filled outside of our network aren’t covered. Pharmacies can dispense up to a 72 hour supply of a medication in an emergency.

Staying safe

We follow federal laws that set standards to guarantee safe and effective pharmacy services. You have the right to know what pharmacy services are covered by your plan. If you would like more information or a copy of our pharmacy coverage policies or benefits, you can:

Download the Apple Health Member Handbook
• Contact Community Health Plan of Washington Customer Service by phone at 1-800-440-1561 (TTY Relay: Dial 7-1-1), from 8 a.m. to 5 p.m., Monday through Friday, or by email at customercare@chpw.org

Download Medication List. Write down all your medication and take it with you to all office visits, hospital stays, and prescription pickups.

Check the latest drug recalls

We participate in pharmacy fraud and abuse monitoring. If you suspect misuse or overuse of pharmaceuticals, call Customer Service.

Express Scripts offers safety information about your prescriptions, including possible side effects and harmful drug interactions.

Log in to Express Scripts or create an account