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 the Pharmacy and Therapeutics Committee, which is made up of local providers and pharmacists. We decide which drugs to cover based on the needs of our members and medical studies and research. All of our drugs are FDA approved.
This formulary is for Medicaid members. If you are looking for the Medicare Advantage Plan formularies, click here.
You will need Adobe Acrobat to read the PDFs. Download it for free.
Checking for prior authorization
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.
How to get prior authorization
There are several ways to get prior authorization for your medicine:
• You can submit a request for a coverage determination review by calling Customer Service from 8 a.m. to 5 p.m, Monday through Friday.
• You can email us at email@example.com to request a coverage determination review.
• You can fax a completed coverage determination request form to Express Scripts.
Dealing with uncovered 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 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 reimbursment. Check the formulary to make sure there were no restrictions on your medication before you ask to be reimbursed. Fill out a reimbursment form and either fax or mail it to Express Scripts.
Get your prescriptions filled
We have an extensive network of pharmacies across Washington, Oregon, Idaho, and Montana, and many of our Community Health Centers have their own pharmacies. To find the pharmacy closest to you, you can:
- Log in to you myCHPW account and search for a pharmacy
- Download our 2017 Network Pharmacy Directory (PDF)
- Log in to your Express Scripts account
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:
• Download the Apple Health Member Handbook
• Contact Community Health Plan of Washington Customer Service by phone at 1-800-440-1561 (TTY Relay: Dial 7-1-1), from 8 a.m. to 5 p.m., Monday through Friday, or by email at firstname.lastname@example.org
We participate in pharmacy fraud and abuse monitoring. If you suspect misuse or overuse of pharmaceuticals, call Customer Service.
Express Scripts offers safety information about your prescriptions, including possible side effects and harmful drug interactions.