Pharmacy

It's important to Coordinated Care that our members receive drug therapy that is appropriate, high quality and cost effective. We work hard to ensure you have access to safe and effective medications that are medically proven to help you get healthy and stay healthy.

Coordinated Care covers certain prescription drugs and over-the-counter drugs when prescribed by a Coordinated Care provider. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dosage or maximum quantities.

The Preferred Drug List (PDL) is the list of drugs covered by Coordinated Care. Coordinated Care works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. The PDL applies to drugs you receive at retail pharmacies. Coordinated Care's PDL is continually evaluated by the Pharmacy and Therapeutics Committee to promote the appropriate and cost-effective use of medications.

View the Preferred Drug List (PDF).

Specialty Drugs: A specialty drug is a prescription drug that requires special handling, administration or monitoring. These are usually only ordered through a specialty pharmacy.

If you are unsure whether your current medication is a specialty drug, please review our Specialty Pharmacy Program (PDF). It has a list of specialty drugs, plus more information about them.

Click to view a list of specialty drugs excluded from this program (PDF).

Your specialty pharmacy is AcariaHealth. They can be reached at 1-855-535-1815.

Over-the-counter contraceptives are covered products that may be dispensed at the pharmacy without a prescription. Covered products include:

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

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.

Certain drugs are considered maintenance medications because they are used to treat long-term conditions or illnesses. If the drug you take is part of the Maintenance Drug Program (PDF), you may ask your provider to send your prescription to the Coordinated Care mail order pharmacy, Homescripts. Homescripts may be reached at 1-800-785-4197 or online at www.myacaria.com/myhomescripts.  

Members can also obtain a 90 day supply (3 month supply) of maintenance medications filled at one time. It’s important to know that not all of our pharmacies are able to fill a 90-day supply, so please check this list of participating pharmacies (PDF) prior to taking your 3 month prescription to them.

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. Only those pharmacies in the Coordinated Care network are listed. 

Coordinated Care covers vaccines at local in-network pharmacies.

  • Varicella Zoster (Shingles) vaccine for member’s age 60 and over are covered at a pharmacy. Under age 60, may require prior authorization.
  • TDAP is only covered for pregnant women at a pharmacy.
  • Covered Vaccines for ages 9 and up: Chickenpox, Hep A, Hep B, HPV, Meningococcal, MMR, Pneumococcal, & Td
  • Flu Vaccines are covered for ages 7 and up.

Members can receive covered vaccines at the same pharmacy where you are covered for flu shots (PDF).

All over the counter (OTC) contraceptives, or birth control, are covered drug products. They do not require a prescription to obtain.

This includes but is not limited to condoms, spermicides, sponges and any emergency contraceptive drug that is FDA-approved to be provided over-the-counter.

To adjudicate a paid claim the pharmacy can process using:
Provider Name: Contraceptive DSHS
NPI #: 5123456787
 

The Washington State Health Care Authority’s opioid clinical policy 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)

If you have questions please visit: https://www.hca.wa.gov/assets/billers-and-providers/Patient-Handout.pdf