This newsletter covers updates to our prescription formulary for non-preferred drugs, and drugs now requiring prior authorization.
Patient Review and Coordination (PRC) Program
The Patient Review and Coordination (PRC) Program is a federal and state requirement of Medicaid that focuses on the health and safety of members. It is used by both the state and the Apple Health managed care plans to control the over-utilization and inappropriate use of medical services by members, by allowing restrictions of members to certain providers. Many of the members are seen by several different providers, have a high number of duplicative medications, use several different pharmacies, and have a high emergency room usage. Based on clinical and utilization findings, members are placed on in the PRC program for at least two years.
To refer a CHPW member for a review for inclusion in the PRC program, please contact CHPW Customer Service at 1-866-907-1902.
You can read the full WAC 182-501-0135 Patient Review and Coordination (PRC) found here: https://www.hca.wa.gov/health-care-services-and-supports/program-administration/wac-182-501-0135-patient-review-and
We welcome your feedback and future topic ideas. Email us at: PharmacyR@chpw.orgRead Past Updates