Wellpoint Formulary
The medications included in the Wellpoint formulary
are reviewed and approved by the Pharmacy and Therapeutics
Committee, which includes Practitioners and Pharmacists from the Wellpoint Provider community.
Please
select a drug from the list below to see all coverage details regarding the
medication. Some medications listed may have additional
requirements or limitations of coverage. These requirements and limits may
include prior authorization, quantity limits, age limits, step therapy or Center for Medicare and Medicaid Services (CMS) coverage requirements.
Medications not listed on the formulary are
considered to be non-formulary and are subject to prior authorization.
Additionally, if a medication is available as a
generic formulation, this will be the preferred agent for Wellpoint, unless
otherwise noted. If you have any questions about coverage of a certain product,
please contact us at 1-833-731-2274, Monday through Friday, 8 a.m. to 5 p.m. PT.
Wellpoint will follow the Washington Health Authority (HCA) PDL for coverage of Atypical Antipsychotics. All members under 18 must utilize state UM's. Children less than 18 years of age that exceed clinically established age/dosing limitations for these medications will require a referral to Second Opinion Network (SON).
The WA HCA PDL can be located at https://www.hca.wa.gov/billers-providers-partners/programs-and-services/apple-health-preferred-drug-list-pdl
Machine Readable Data for Prescription Drug
Formulary: Washington Medicaid Machine Readable File