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. You will need Adobe Acrobat to read the PDFs. Download it for free.
2020 Prescription Coverage
To request a hard copy 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 711), from 8 a.m. to 5 p.m., Monday through Friday.
Get a Larger Supply of Select Medications
CHPW members can get a 90-day supply of select generic oral medication for asthma, hypertension, diabetes, heart failure, and hyperlipidemia, as well as generic antidepressants and antipsychotics. 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.
Prescriptions Mailed to Your Home
Call, mail or have your prescriber send in your prescriptions to a Walmart pharmacy and start getting your medicine sent right to your house.
- Call: 1-800-273-3455. Walmart will set up your profile over the phone and get your prescriptions into their system.
- Mail: Fill out the Prescription Order Form. Mail your original written prescriptions and the Order Form to the address on the form.
- Talk to your prescriber: Ask them to call in your prescription or fax in the Prescription Order Form.
Refill your prescriptions
You can contact Walmart's Home Delivery service four ways to request a refill.
- Call 1-800-273-3455 and follow the automated prompts.
- Email firstname.lastname@example.org.
- Mail your name, RX number, and phone number to: Walmart Home Delivery, 1025 W. Trinity Mills Rd, Carrollton, TX 75006.
- Fax your name, RX number and phone number to: 1-800-406-8976.
Download the Walmart App to manage your prescriptions, refills, and deliveries from your phone.
Read more about the program: www.walmart.com/homedelivery
Personal Medication Coach Program
The Personal Medication Coach Program helps member who are managing more than one medical issue and are taking multiple medications. We partner with SinfoniaRx to work with you and your doctors and make sure your medications are working to improve your health.
You can learn more about this program by visiting sinfoniarx.com or calling 1-844-866-3730.
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.
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. Many of our Community Health Centers have their own pharmacies. To find the pharmacy closest to you, you can:
- Log in to your myCHPW account and search for a pharmacy
- Log in to your Express Scripts account
- Browse our Pharmacy Directory (PDF)
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.
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.
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:
- Check your coverage in your member benefit handbook
- Contact Community Health Plan of Washington Customer Service by phone at 1-800-440-1561 (TTY Relay: Dial 711), from 8 a.m. to 5 p.m., Monday through Friday, or by email at email@example.com
Keep track of medication: Download a medication list. Write down your medication, supplements, and over the counter products. Bring the list with you to all your appointments.
Recalled medication: Sometimes prescriptions are recalled. If your prescription is recalled, do not continue to take it and contact the provider who prescribed it to you right away. Check the latest drug recalls.
Help stop fraud: We participate in pharmacy fraud and abuse monitoring. If you suspect misuse or overuse of pharmaceuticals, call Customer Service.
Understand your prescriptions: 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