Requesting Exceptions and Coverage Determination - Community Health Plan of Washington - Medicare Advantage

Prescription Drug Coverage

Our prescription drug formularies provide a list of medication that is covered by the plan. If you are taking a medication that is not on the list, you can ask us to make an exception. You can also ask us to waive restrictions or limitations on your drug. For example, quantity limits or step therapy restrictions.

You can use our online formulary search tool to see if a drug has any restrictions.

Requesting an Exception

You can submit a request for a coverage determination review by sending in a Coverage Determination Request form or filling out the online form.

Download the Coverage Determination Request Form

Complete your Coverage Determination Request Online

If coverage for a specific drug has been denied, you can ask us to reconsider our decision. Please submit a request for redetermination by sending in a Redetermination Request form (PDF) by mail or submitting an online form.

Download the Redetermination Request Form

Complete your Coverage Redetermination Request Online

We must make our decision within 72 hours of getting your prescribing provider’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get your prescribing provider’s supporting statement.

Who to Contact

You can submit a request for a coverage determination by calling Customer Service between 8 a.m. and 8 p.m., seven days a week.

Prospective Members: please call: 1-800-944-1247

Current Members: please call: 1-800-942-0247 (TTY Relay: Dial 7-1-1)

You can fax your completed forms to 1-877-251-5896 (Coverage Determinations) or 1-800-652-7050 (Redetermination Requests).

Send written requests or mail your completed forms to:

Express Scripts, Inc
Attn: Prior Authorization – Part D
Mail Route B401-03
8640 Evans Road
St. Louis, MO 63134


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.



Sales Team

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Phone: 1-800-944-1247
Email: [email protected]