There is no substitute for safety when prescribing medication.

Get a current list of pharmacies in the network or find out which drugs are on the formulary:

Search Pharmacies buttonSearch Formulary button

 

 

Important: The formulary and search do not apply to Medicare Advantage Plan members. Please refer to the CHPW Medicare Advantage website for information on Medicare Plan coverage.

Changes Coming to 2019 Formulary

On January 1, 2019, all managed care plans and Apple Health fee-for-service programs will continue to phase in a Single Preferred Drug List (PDL).

This change is mandated by the Washington State Legislature.

The Health Care Authority is working with managed care plans that serve Apple Health clients to create the Apple Health PDL. On January 1, 2019, the PDL will be adding an additional 74 drug classes. Managed care plans will continue to use their own preferred drug lists for drugs not included in the Apple Health PDL.

Please contact customercare@chpw.org with any questions.

Prior Authorization

To request a prior authorization, step therapy, nonformulary, or quantity limit override, please call ESI at 1-844-605-8168, 24 hours a day, 7 days a week, and speak to a prior authorization service specialist. This specialist will review medical information and criteria with the provider or designee regarding the need for the requested drug. 

Pharmacy Reimbursement Issues

If you are having an issue with reimbursement, please submit an inquiry to ESI through their Pharmacist Resource Center

Pharmacy Emergency Fills

Emergency fills may be covered to prevent interruptions in therapy during an emergency. View our policy on emergency fills on our Policies and Procedures page.

Carved out drugs: Covered by Fee-for-Service

  • Axicabtagene ciloleucel (Yescarta)
  • Burosumab-twza (Crysvita) – effective 1/1/19
  • Cerliponase alfa (Brineura)
  • Edavarone (Radicava)
  • Elapegademase (Revcovi) – effective 7/1/2019
  • Emapalumab-lzsg (Gamifant) – effective 7/1/19
  • Eterplirsen (Exondys 51)
  • Lutetium Lu 177 dotatate (Lutathera) – effective 7/1/2019
  • Nusinersen (Spinraza)
  • Onasemnogene abeparvovec (Zolgensma) – effective 7/1/2019
  • Pegvaliase-pgpz (Palynziq) – effective 1/1/19
  • Tisagenlecleucel-t (Kymriah)
  • Voretigene neparvovec-rzyl (Luxterna)  
  • Dental Prescriptions
  • Hepatitis C medication
  • Hemophilia medication

The Washington State HCA will be responsible for ALL pre-authorizations and approvals for therapy based on HCA clinical guidelines. HCA Policy is available here

Medications available for 90-day fills

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.

90 Day Fill List

Personal Medication Coach Program

The Personal Medication Coach Program is a service for members with multiple health conditions and who take multiple medications. This program is offered through a partnership between Community Health Plan of Washington and SinfoniaRx. 

The Personal Medication Coach Program works with doctors and patients to ensure that medications are working to improve health.

If you believe one of your patients would benefit from Personal Medication Coaching, ask them to visit sinfoniarx.com or call1-844-866-3730 to get started.

Eligibility Requirements

If you are looking for Medication Therapy Management for a Medicare Advantage member, visit the CHPW Medicare Advantage website for information on Medicare Medication Therapy Management information.

Patient Review and Coordination Program

Our Patient Review and Coordination (PRC) Program helps members use their medical services safely and appropriately.

Members who are selected for PRC must choose one primary care provider, pharmacy, and hospital. One primary care provider makes sure medical care and prescriptions are coordinated for the health and safety of the member. 

To refer a patient to the PRC program or learn more, call us at 1-866-907-1902.

Pharmacy and Therapeutics (P&T) Committee

Our P&T Committee meets to evaluate our formulary, prior authorization requirements, and safety measures to ensure quality. Read the most recent decisions:

  • March 25, 2019: No Clinical Decisions
  • November 14, 2018: No Clinical Decisions
  • July 13, 2018: No Clinical Decisions
  • March 2, 2018: No Clinical Decisions

Medication Safety

Be sure to read the latest Drug Recall Report for updates on medications that are recalled due to safety issues.