Pharmacy information
Apple Health Single Preferred Drug List
The Apple Health Single Preferred Drug List (PDL) is a list of all brand-name and generic drugs available on the plan. The Health Care Authority (HCA) implemented the Apple Health Single PDL. All managed care plans and the fee-for-service program serving Apple Health clients use this PDL. To see what drugs are preferred and whether they need a prior authorization (PA), please reference the Apple Health resources on this page.
Wellpoint Washington, Inc. preferred drug list
Wellpoint manages medications and supplies that are not part of the Apple Health Single PDL. For medications that are not included in the Apple Health Single PDL, such as diabetic supplies, spacers and vaccines, please reference the Wellpoint PDL .
Prior authorization
Some drugs, drug combinations and drug doses require prior authorization (PA). To submit electronic prior authorization (ePA) requests, use CoverMyMeds . Creating an account is free.
While ePA helps streamline the PA process, you may initiate a new PA request by fax or phone. For medical injectable drugs, please use the Medical Injectables Prior Authorization Form. Please also include HCPCS billing code for the injectable drug request.
Phone: 1-833-731-2274
Retail Fax: 1-844-493-9207
Medical Injectables Fax: 1-844-493-9209
Medication refills
Members can fill a 90-day supply of maintenance medications at retail pharmacies. Members can refill their prescriptions every 72 days for a 90-day supply of maintenance medications or every 24 days for a 30-day supply.
Pharmacy emergency fills
A seven-day emergency supply of medications is covered to prevent interruptions in therapy during an emergency, such as a natural disaster.
Emergency fill also means that the dispensing pharmacist used their professional judgment to meet a member’s urgent medical needs. If the dispensing pharmacist determines the member has an urgent medical need, they can:
- Dispense the medication to the member and use PAMC 22223333444 (prior authorization medical certification code) at the point of sale to process the emergency supply (up to a seven-day supply)
- Call the CarelonRx* Pharmacy Help Desk at 1-833-253-4453 if assistance is needed with an emergency supply fill or more than a seven-day supply is required
Exception to the Rule
If a prescribed drug is not listed on the PDL, contact Wellpoint. You may be able to receive it through the Exception to the Rule (ETR) process. You can request Wellpoint to cover it under the ETR process. Please fax your request to 1-855-292-3370.
Pharmacy paper claims
To submit a pharmacy paper claim, please complete the Prescription Reimbursement Claim Form and mail it to the address listed on the form or fax it in to the fax number listed on the form for processing.
Find a pharmacy
Find a pharmacy in the network using the pharmacy search tool:
Mail Order Pharmacy
We offer home delivery through CarelonRx Pharmacy as an option for members to fill up to a 90-day supply of their maintenance medications. Members can download and print the physician fax form from the website of our pharmacy benefits manager, with the new prescription for a 90-day supply. When you write the new prescription, you can fax or e-fax the form and prescription to the number on the form. We will take it from there.
*CoverMyMeds is an independent company providing pharmacy benefit management services on behalf of Wellpoint Washington, Inc.
**CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Wellpoint Washington, Inc.
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