Prescription Drug Coverage - Cascade Select powered by CHPW - Cascade Select

Prescription Drug Coverage

Prescription Coverage That Works for You

You want to know you can get your medicine when you need it. We get that. On this page, you’ll find Community Health Network of Washington’s (CHNW) list of covered prescriptions (formulary), our directory of participating (in-network) pharmacies, and information about how to safely, reliably, and conveniently use your medication benefits. Your share of the cost for prescription drugs depends on your plan and the type of drug (Generic, Preferred Brand, Non-Preferred Brand, and Specialty).

What We Cover

CHNW covers drugs based on medical science and the needs of our members. You’ll find a full list of the drugs we cover in our formulary.

2021 Prescription Coverage

➔ Search our 2021 Gold and Bronze Plan Formulary

➔ Search our 2021 Silver Plan Formulary

➔ Download 2021 formulary as a PDF

To request a free hard copy of the formulary, please call Customer Service at 1-866-907-1906 (TTY Relay: Dial 711), from 8 a.m. to 5 p.m., Monday through Friday.

Find a Pharmacy

CHNW has an extensive network of participating pharmacies across Washington. Your local Community Health Center pharmacies are also included on this list and provide comprehensive and convenient services at an affordable price. Please contact your Community Health Center to find out more about the onsite pharmacies. Bring your CHNW ID card when you pick up your prescription.

➔ Download 2021 Pharmacy Directory as a PDF

Get a Larger Supply of Select Medications

Our members can get a 90-day supply of select medications. 90-day supply of prescriptions are available at all participating network pharmacies.

Have Prescriptions Mailed to Your Home

Here are 3 simple ways to get started with home delivery.

  • ePrescribe: Ask your doctor to send your prescriptions electronically to Express Scripts Pharmacy.
  • Phone: Call 1-888-637-8383. Available 24 hours a day (including holidays), 7 days a week to talk about getting your long-term medicine delivered. TTY users: 1-800-759-1089.
  • Online: Visit express-scripts.com or download the mobile app for free. You need to register with your member ID card. Follow the prompts to move your prescriptions to home delivery.

Prior Authorization and Formulary Exception

Prior Authorization

Some drugs require prior authorization. Check whether your medicine needs prior authorization or has any coverage restrictions by referring to the Clinical Review Criteria for Prescription Drugs.

Please note, not all medications listed in the Clinical Review Criteria link will be covered on the formulary. Non-formulary medications are subject to the Medical Necessity for Non-Formulary Medications policy. Please consult the formulary and Evidence of Coverage (EOC) to verify coverage. 

You can submit a request for prior authorization by sending in a Prior Authorization form. You can fax your completed Prior Authorization form to 1-877-251-5896.

Send written requests or mail your completed form to:

Express Scripts
Attn: Pharmacy Coverage Determinations
P.O. Box 66588
St. Louis, MO 63166-6588
Phone: 1-800-753-2851

Please register or log into express-scripts.com to get your plan details including Prior Authorization status.

If your prior authorization request is denied by Express Scripts, you may appeal the decision with CHNW. Read about how to appeal or file a grievance.

Formulary Exception

Check whether your medicine needs formulary exception or has any coverage restrictions by referring to the Clinical Review Criteria for Prescription Drugs.

Please note, not all medications listed in the Clinical Review Criteria link will be covered on the formulary. Non-formulary medications are subject to the Medical Necessity for Non-Formulary Medications policy. Please consult the formulary and Evidence of Coverage (EOC) to verify coverage. 

If you need medicine that isn’t listed on our formulary, you or your provider can call or submit your request in writing to:

Express Scripts
Attn: Pharmacy Coverage Determinations
P.O. Box 66588
St. Louis, MO 63166-6588
Phone: 1-800-753-2851

If your formulary exception request is denied by Express Scripts, you may appeal the decision with CHNW. Read about how to appeal or file a grievance.

Staying Safe

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:

  1. Check your coverage in your Evidence of Coverage (EOC).
  2. Contact Community Health Network of Washington Customer Service by phone at 1-866-907-1906 (TTY Relay: Dial 711), from 8 a.m. to 5 p.m., Monday through Friday, or by email at [email protected].

Keep track of medication: Download a medication list. Write down your medication, supplements, and over-the-counter products. Bring the list with you to all your appointments.

Recalled medication: If your prescription is recalled, contact the provider who prescribed it to you right away. Do not continue to take the recalled medication. Check the latest drug recalls.

Help stop fraud: We participate in monitoring for pharmacy fraud and abuse. If you suspect misuse or overuse of pharmaceuticals, call Customer Service.

Understand your prescriptions: Express Scripts offers safety information about your prescriptions, including possible side effects and harmful drug interactions.

Questions about Prescription Drug Coverage?

If you have any questions about our formulary drug list, copay levels, or policies, please call Customer Service between 8 a.m. and 5 p.m., Monday through Friday. Current members should call 1-866-907-1906 (TTY Relay: 711). Prospective members should call 1-833-993-0181 (TTY Relay: 711).

DID YOU KNOW...?

Stay on Top of Your Prescriptions

Woman grabbing a prescriptionDid you know that certain prescription medicines are available as a 90-day supply? Medicine that you take on a long-term basis to manage your health is called a “maintenance drug.” A 90-day supply makes it easier to keep taking the medicine you need to feel your best. You may also be eligible to receive your long-term medications through free home delivery.

LEARN MORE