Prescription medication can be a critical part of your health care. That's why Community Health Plan of Washington makes it easy for you to get your prescriptions filled.
We partner with Express Scripts and use a certain list of covered drugs, or formulary. Our Pharmacy and Therapeutics Committee, composed of providers and pharmacists, chooses FDA-approved drugs for the formulary based on medical studies and research.
Get a current list of pharmacies in the network or find out which drugs are on the formulary:
- You can also read or download the 2017 Community Health Plan Formulary (PDF).
- Log in to your member account to find a pharmacy OR
- Download the Network Pharmacy Directory (PDF)
Important: The formulary search does not apply to Medicare Advantage Plan members. If you are a Medicare Advantage member, see the Medicare Advantage Plan formulary.
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:
- Contact our Customer Service at 1-800-440-1561 (TTY Relay: Dial 7-1-1), from 8 a.m. to 5 p.m., Monday through Friday. You can also email us at firstname.lastname@example.org.
Things to Remember
Always show your ID: You must show your Community Health Plan of Washington ID card and have your prescriptions filled at a pharmacy in our network.
Prior authorization: Before we pay for certain drugs, you must get an approval from Community Health Plan of Washington. There are several ways you can get approval:
- You can submit a request for a coverage determination review by calling Customer Service at 1-800-440-1561 (TTY Relay: Dial 7-1-1), 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 in a request for a coverage determination review by filling out and submitting a request form. You will need Adobe Acrobat reader to view the PDF documents on this website. Download Adobe Acrobat Reader for free.
Be sure to read our Drug Recalls Report for updates on medications that are recalled due to safety issues.
Maximum quantity limits are required on some drugs to ensure safe use.
Use of half tablets is recommended on certain drugs. The pharmacy will give you a tablet splitter with no copay required from you when you present a prescription for a drug taken in half tablets.
Pharmacy fraud and abuse: We monitor the safe use of medication through a fraud and abuse program and reserve the right to limit a member’s provider and pharmacy selection if overuse or misuse has been identified.