Pharmacy

We use a large network that gives you access to retail, mail-order, and specialty pharmacies. This allows our members to receive their medications conveniently and at a lower cost. We work closely with our pharmacy partners with you, our Coordinated Care member, in mind. Together, we focus on being clear about prices and lowering the total cost of care.

Coordinated Care does not cover all drugs. Some need prior authorization. Some drugs have limits on age, dosage or quantities.
The Preferred Drug List (PDL) is the list of drugs covered by Coordinated Care. Coordinated Care works closely with the Washington State Health Care Authority (HCA), providers and pharmacists. Coordinated Care covers medications used to treat a variety of conditions and diseases. The PDL applies to drugs you receive from retail, mail-order, and specialty pharmacies.

Click the links below to view the Coordinated Care Preferred Drug List (PDL) documents:

• Coordinated Care (Apple Health) Preferred Drug List (PDF).
• Coordinated Care (Apple Health Expansion) Preferred Drug List (PDF)

To see the latest quarterly changes to the PDL, download Coordinated Care’s Drug List updates (PDF).

If a prescription drug you take is no longer preferred, you will be told by your doctor, Managed Care Plan, or pharmacy. You may need to change your current drug(s). If you receive a letter in the mail from Coordinated Care, read it carefully. Talk to your doctor at your next visit or call their office. If you go to the pharmacy to refill your prescription before your next visit, you might be told that your drug needs prior authorization. We will work with your prescriber to cover a drug that meets your needs. You will not lose drug coverage. Please note that you will also still use the same Apple Health ID.

If you have questions or problems with your prescription, call Coordinated Care member services by dialing the toll-free number 1-877-644-4613 on your Apple Health ID Card.

To get a free paper copy of the PDL, contact Coordinated Care. We will send you a copy within five business days.

What is a specialty Medication?

A specialty drug is a prescription that needs special handling, administration, or attention. These are often only ordered through a specialty pharmacy.

What is a Specialty Pharmacy?

A specialty pharmacy provides services and medications needed to treat members with chronic, complex, or rare conditions. The medication provided by specialty pharmacies are often considered high-touch or high-cost. Specialty pharmacies have experts who provide more services than regular pharmacies. Specialty pharmacy services can include clinical help, such as training on how to take medication.

Access to Specialty Medications

Through our specialty pharmacy services, we offer support for high-cost medications and complex therapies. We make sure members have access to the treatments you need with the guidance of a dedicated pharmacy team.

Your Preferred Specialty Pharmacy is AcariaHealth

AcariaHealth is a national pharmacy dedicated to transforming lives through compassionate care. They focus on enhancing the health and outcomes of people with complex medical conditions. AcariaHealth takes a collaborative approach to care. They work closely with you and your health care providers to tailor treatments to meet your unique needs.

Contact AcariaHealth

Phone: 1-800-511-5144 (TTY: 711)
Fax: 1-877-541-1503
customercare@acariahealth.com

Learn more about AcariaHealth at AcariaHealth.com.

While AcariaHealth is your preferred specialty pharmacy provider, members have a say in their pharmacy. You can have your prescriptions filled by any willing in-network specialty pharmacy provider of your choosing.
 

You can have your prescriptions filled at a network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your Coordinated Care ID Card. If you need help finding a pharmacy near you, call us or check online.

The products listed on our Preferred Drug List (PDF) with the "MP" marker are maintenance medications of which members can receive up to a 90-day supply. Maintenance medications treat long-term conditions or illnesses. 

The maintenance drug list can change. It may not include everything and some medicines may have other coverage rules. Contact us if you have questions.

Mail-Order Benefits

Coordinated Care offers a mail-order pharmacy service that allows members to receive a 90-day supply of certain maintenance medications delivered at their door. These medications save time and increase adherence.

For more information about our mail-order benefits, contact Express Scripts® Pharmacy.

Phone: 1-833-750-4300 (TTY: 1-800-899-2114)
Fax: 1-800-837-0959
 

You can have your prescriptions filled at a network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your Coordinted Care ID card.

To find a pharmacy that is in the Coordinated Care network, you can use the Find a Provider tool. Type in your city or zip code. Then click "Update." Choose "Other" and type the name of your pharmacy. You can also select the pharmacy type in the "Select Specialty" area. The pharmacies listed are in the Coordinated Care network. 

For a list of covered flu shots and vaccines at local in-network pharmacies, please visit Coordinated Care’s Preferred Drug List (PDF). 

What is a biologic drug?

A biologic is a drug made from living cells. They are used to treat many kinds of diseases like skin conditions, arthritis, and cancers. There are many biologics used in the United States.

What is a biosimilar drug?

A biosimilar is a biologic that is a near-copy of the original drug. The U.S. Food and Drug Administration (FDA) approves biosimilars based on clinical studies. Biosimilars and the original drug are very alike, so they are just as safe and effective.

Is a biosimilar the same as a generic drug?

Not exactly. Biosimilars are like generic drugs in some ways. Both are copies of the original drug at a lower cost. The difference is a biologic drug cannot be exactly copied since it is made from living cells. Biosimilars are not exact copies of the original drug. Since they are so alike, a biosimilar does not have clinically meaningful changes from the original drug.

Why should I switch to a biosimilar?

• Provides the same treatment benefits
• Are given the same way
• More options
• May lower costs

Biosimilars are safe and can offer more treatment solutions.

Ask your doctor if biosimilar medications are available to you.

Our customer service team is also here to help. We can figure out your coverage for biosimilars to treat your condition.

Covered products include over-the-counter contraceptives. Pharmacies can provide these products without a prescription. Covered products include:

• Condoms (including female)
• Spermicides
• Sponges
• Emergency Contraceptive drug (plan B) that is FDA approved
  for over-the-counter dispensing
  

The Washington State Health Care Authority’s opioid clinical policy (PDF) is an addiction prevention and patient safety tool. It is meant to protect patients and combat the opioid crisis.

When patients are prescribed more pills than they need for pain relief, extra pills can be misused or sold. The policy limits the number of pills in a prescription for short-term use:

• For children and adolescents age 20 or younger: About a three-day supply (18 pills or liquid doses)
• For adults age 21 or older: About a seven-day supply (42 pills or liquid doses)

As of November 1, 2019, Apple Health set a safety limit on the total daily dose of opioids. Doctors measure opioid doses in units called morphine milligram equivalents (MME). If your prescriptions go over 120 MME per day, your doctor must sign an opioid attestation form. This safety limit helps make sure your doctor is following best care practices.

Prior Authorization Fax: 1-833-645-2734
Prior Authorization Phone: 1-866-716-5099
Clinical Hours: Monday – Friday 7 a.m. - 5 p.m. (PST)
Help Desk: 1-877-250-6176

Pharmacy Services will respond via fax or phone within 24 hours of receipt of the prior authorization request.