Community Health Plan of Washington (CHPW) requires prior authorization for certain professionally administered medications
These professionally administered drugs require prior authorization. Review CHPW’s Clinical Coverage Criteria for these drugs. For medications that are listed as requiring prior authorization but do not have CHPW Clinical Coverage Criteria, MCG guidelines will be used to determine medical necessity.
Prior authorization for self-administered medication
Any pharmaceutical not listed on our formulary requires prior authorization. For self-administered drugs requiring prior authorization, please contact Express Scripts at 1-844-605-8168 or use CoverMyMeds.com to start the prior authorization process.
Any drug not listed in the formulary will require prior authorization.
Submitting a Prior Authorization Request for professionally administered drugs
ONLINE (preferred) through the Care Management Portal (JIVA)
Request a Care Management Portal account to check eligibility and authorization status, print approval letters, and submit requests online 24/7.