Prescription Coverage - Washington State Local Health Insurance - CHPW

Prescription Coverage

Prescription coverage that works for you

You want to know you can get your medicine when you need it.  We get that.  On this page, you’ll find Community Health Plan of Washington’s (CHPW) list of covered prescriptions (formulary), our directory of in-network pharmacies, and information about how to safely, reliably, and conveniently use your medication benefits.

What we cover

CHPW and the Washington State Health Care Authority (HCA) cover drugs based on medical science and the needs of our members. You’ll find a full list of the drugs we cover in our formulary.

2020 Prescription Coverage

➔ Search our 2020 formulary

➔ Download 2020 formulary as PDF

To request a free hard copy of the formulary, please call Customer Service at 1-800-440-1561 (TTY Relay: Dial 711), from 8 a.m. to 5 p.m., Monday through Friday.

Find a pharmacy

CHPW has an extensive network of pharmacies across Washington, Oregon, and Idaho. Many of our Community Health Centers have their own pharmacies, too.

Find the pharmacy closest to you:

Bring your CHPW 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.

*CHPW partners with Express Scripts to give you access to a large network of pharmacies and range of covered prescriptions. Go to Express Scripts to log in or create an account. From your account, you can manage prescriptions, search for pharmacies, and learn important safety information about your medicine.

Special medications, 90-day supplies, and travel

Get a Larger Supply of Select Medications

CHPW covers 90-day supplies for most chronic medications. Ask your physician or pharmacist for a 90-day supply of your medications at your next visit.

Special update during COVID-19:
Restrictions around filling a prescription too soon have been lifted for many medications.

Our members can get a 90-day supply of select medications used to treat chronic conditions (known as maintenance medications) such as high blood pressure, diabetes, and depression.

Larger supplies of prescriptions are available exclusively through Community Health Center pharmacies and select network pharmacies (preferred pharmacies). Ask your provider if any of the medications you are taking are eligible for a 90-day fill.

You may also be eligible for free home delivery of your long-term medications.

Specialty drugs

Some complex or chronic illnesses require specialty drugs that regular CHPW pharmacies don’t offer. Specialty drugs are covered when 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

Travel

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.

Have prescriptions mailed to your home

Have your medicine delivered to your house with Walmart’s Home Delivery service.

Get started

  • Call: 1-800-273-3455. Walmart will set up your profile over the phone and put 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

  • Call 1-800-273-3455 and follow the automated prompts.
  • Email [email protected].
  • 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

Special update during COVID-19:
Rite Aid:

Rite Aid is offering free delivery for our Apple Health members during this outbreak. To learn what your mailing options are, contact the pharmacy where you get your prescriptions filled.

Walgreens Express:

Walgreens is offering home delivery of prescriptions as a temporary service to our members.

To get your prescriptions delivered through Walgreens, you must sign up with Walgreens Express. Text JoinRx to 21525. (For Spanish, text UneteRx.) When your prescription is ready, you will receive a text alert with a Walgreens Express link. Follow the link, choose delivery as your option, and confirm your address.

Read more about the program: https://www.walgreens.com/topic/pharmacy/walgreens-express.jsp

Walmart’s Home Delivery Service:

  • Call 1-800-273-3455 and follow the automated prompts.
  • Email [email protected].
  • 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

Mail order from your CHC:

Some Community Health Centers provide home delivery of your prescriptions. Check with your CHC if home delivery is available.

Personal Medication Coach Program

The Personal Medication Coach Program helps members who are managing more than one medical issue and are taking multiple medications. We partner with SinfoniaRx to make sure your medications are working effectively and safely.

You can learn more about this program by visiting sinfoniarx.com or calling 1-844-866-3730.

Prior Authorization

Some drugs require prior authorization. This means CHPW has to approve coverage before we can help you pay for them. Check whether your medicine needs prior authorization or has any coverage restrictions by calling Customer Service or checking our list of covered medications (formulary).

You can submit a request for a coverage determination review by sending in a Coverage Determination Request form or filling out the online form.

Non-covered 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 may appeal the decision with CHPW. 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.

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:

  1. Check your coverage in your member benefit handbook
  2. 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 protected]

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: If your prescription is recalled, contact the provider who prescribed it to you right away. Do not continue to take the recalled medication. Check the latest drug recalls.

Help stop fraud: We participate in monitoring for pharmacy fraud and abuse. 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.

Become a CHPW member:

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