Community Health Plan of Washington requires prior authorization for the following: 

These professionally administered drugs require prior authorization. Review CHPW's Clinical Coverage Criteria for these drugs. For prior authorization requirements for self-administered drugs, please search our online formulary.

A, B, C

  • Abatacept (Orencia)
  • Ado-trastuzumab emtansine (Kadcyla)
  • Alemtuzumab (Lemtrada)
  • Bevacizumab (Avastin)
  • Brentuximab vedotin (Adcetris) for injection, for intravenous use
  • Canakinumab (Ilaris)
  • Cetuximab (Erbitux)

D-G

  • Denosumab (Prolia)
  • Denosumab (Xgeva)
  • Docetaxel (Docefrez, Taxotere, docetaxel)
  • Ecallantide (Kalbitor)
  • Epoetin alfa (Epogen, Procrit)
  • Epoprostenol (Flolan, Veletri, generics)
  • Eteplirsen (Exondys 51) injection for intravenous use
  • Filgrastim (Neupogen, Zarxio)
  • Golimumab (Simponi Aria)

H, I

  • Hyaluronic acid derivatives (Euflexxa, Gel-One, Gelsyn-3, GenVisc 850, Hyalgan, Hymovis, Monovisc, Orthovisc, Supartz/Supartz FX, Synvisc, Synvisc-One)
  • Hydroxyprogesterone caproate (Makena) injection for intramuscular use: For Medicaid: Pharmacy Benefit, please direct prescriptions to Accredo Specialty Pharmacy at 1-800-903-8224. For Medicare: Prior Authorization required
  • Ibandronate (Boniva)
  • Immune Globulin Intravenous (IVIG) (Bivigam, Carimune NF Nanofiltered, Flebogamma DIF, Gammagard Liquid, Gammagard S/D < 1 mcg/dL in 5% solution, Gammaked, Gammaplex, Gamunex-C, Octagam, Privigen Liquid)Immune globulin subcutaneous
  • Infliximab products - Inflectra (infliximab-dyyb) injection for intravenous use; Remicade (infliximab) for intravenous infusion
  • Ipilimumab (Yervoy)

J-N

  • Mepolizumab (Nucala) injection for subcutaneous use
  • Nanoparticle albumin bound paclitaxel (Abraxane)
  • Natalizumab (Tysabri)
  • Nivolumab (Opdivo)
  • Nusinersen (Spinraza) injection for intrathecal use

O, P

  • Ocrelizuman (Ocrevus) injection for intravenous use
  • Omalizumab (Xolair) injection for subcutaneous use
  • Palivizumab (Synagis)
  • Panitumumab (Vectibix)

Q-T

  • Ramucirumab (Cyramza)
  • Rituximab (Rituxan)
  • Sargramostim (Leukine)
  • Tbo-filgrastim (Granix)
  • Tocilizumab (Actemra)
  • Trastuzumab
  • Treprostinil (Remodulin)

U-Z

  • Vedolizuman (Entyvio)
  • Zoledronic acid (Reclast)
  • Zoledronic acid (Zometa)
  • Ziv-aflibercept (Zaltrap)

Submitting a Prior Authorization Request

ONLINE (preferred) through the Care Management Portal
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 form matching your request listed on the main Prior Authorization page and fax to the number listed on the form.

Please contact CHPW with any questions or concerns.