2019 Pharmacy Preferred Newsletter - Community Health Plan of Washington - Medicare Advantage

2019 Pharmacy Preferred Newsletter

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


Making Connections

We welcome your feedback and future topic ideas. Email us at: PharmacyR@chpw.org

Read the full September Pharmacy Preferred Newsletter

Read Past Updates

DID YOU KNOW...?

A Nap a Day Could Keep The Doctor Away

An older man taking a nap on the couch.Many Americans do not get enough sleep and this can contribute to a number of health issues. Taking a nap during the day can help your body restore itself and promotes brain and heart health. A 20-minute nap has a variety of health benefits – from improved mood, to better focus and memory function. In some cultures, napping is even prescribed as a health treatment by doctors!

If you have trouble sleeping, take steps to improve your quality of sleep.

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