Professionally Administered Medications - Washington State Local Health Insurance - CHPW

Professionally Administered Medications

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.

Medicaid Formulary
Medicare Formularies

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.

Fax: Fill out the Prior Authorization Request Form and fax it, with supporting documentation, to the number listed on the form
Please contact CHPW with any questions or concerns.

Professionally-administered medication requiring prior authorization (2021)

2021 Prior Authorization List and Utilization Guidelines

Professionally-administered medication requiring prior authorization (2020)

2020 Prior Authorization List and Utilization Guidelines

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