This formulary is a closed formulary. You also may qualify if your yearly income is $18,735 or less if you are single with no dependents, or $25,365 or less if you are married and living with your spouse with no dependents, and your resources are less than $14,610 if single or $29,160 if you are married and living with your spouse. This formulary was updated on 09/01/2020. You can also download the Enrollment Checklist as a guide.If you get Extra Help from Medicare for your Medicare prescription drug plan costs, your monthly plan premium will be reduced. In compliance with the ACA, Capital Health Plan offers this coverage to all Commercial members.Please contact Member Services at 850-383-3311 for additional information.For up-to-date information on drug recalls, market withdrawals, and safety alerts, visit the U.S. Food and Drug Administration’s (FDA) website at We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. We are pleased to provide the 2020 MetroPlus Health Plan Formulary as a useful reference and informational tool. The TDD number for the hearing impaired is (850) 383-3534. After hours or on a weekend, you can call (850) 383-3333 or toll-free (800) 390-1434. You can qualify if you are eligible for Medicaid as well as Medicare. Get information on our Medicaid and Medicare plans and our Washington State Health Benefits … 2020 Formulary (PDF) Fidelis Medicare Advantage and Dual Advantage Plans. ©2020 Community Health Plan of Washington 2020 Prescription Coverage. The Trusted Health Plan, District of Columbia Formulary is designed to assist practitioners in selecting clinically appropriate If you are a member and have questions please refer to your Member Handbook or call Member Services at one of the numbers listed below. The drug formulary is selected by Capital Health Plan in consultation with a team of health care providers. This document can assist medical providers in selecting clinically appropriate and cost-effective products for their patients. To enroll in a Community Health Plan of Washington Medicaid or Medicare Advantage plan, you must be eligible and live in our Medicare service area (Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Franklin, Grant, King, Kitsap, Lewis, Pierce, Okanogan, Skagit, Snohomish, Spokane, Thurston, Walla Walla,Whatcom, Yakima counties in Washington state) or Medicaid regions. Decisions made early and communicated plainly may have tremendous value for you and your family.To obtain a copy of Five Wishes, an advanced directive document that addresses all of an individual's needs (medical, personal, emotional, and spiritual), call Capital Health Plan's Health Information Line at (850) 383-3400.Through the Planning Early About Care at the End (PEACE) program, Big Bend Hospice offers individualized assistance in completing the Five Wishes Advanced Directive. An advanced directive is simply a statement, made while you are competent, about the medical treatment you want if you can’t make those decisions later. Staff from the Pharmacy Services department may need to request additional information from you or your prescribing doctor. To schedule an appointment with a PEACE facilitator, contact Big Bend Hospice at (850) 878-5310 or visit the For instructions on how to use the form to appoint a representative, visit Capital Health Plan makes health care decisions to ensure quality treatment and efficient use of resources. The drug formulary is selected by Capital Health Plan in consultation with a team of health care providers. You may access the Nondiscrimination and Accessibility Notice © 2020 Capital Health Plan, An Independent Licensee of the Blue Cross and Blue Shield Association. You can also use our online formulary search tool. 2020 Pharmacy Benefits. If your drug has a quantity limit, you can ask CHP to cover a quantity over the stated limit. CHPW is committed to Washington's health. You will receive notice when necessary.If you have questions please call Member Services at We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. This is not a complete description of benefits, please contact us for more information.You will need Adobe reader to open PDFs on the site. Your drug formulary lists all drugs your plan overs, plus any special rules you'll need to follow with certain 2020 Drug Formulary (PDF) 2020 Formulary Quick Reference Guide (PDF) Qualified Health Plans (Metal-Level Products) 2020 Formulary (PDF) Essential Plan. To request a hard copy of the formulary be sent to you in the mail free of charge, please call Customer Service at 1-800-440-1561 (TTY Relay: Dial 711), from 8 a.m. to 5 p.m., Monday through Friday. View more information about Capital Health Plan Advantage Plus (HMO), Preferred Advantage (HMO), and Retiree Advantage (HMO) are HMO plans with a Medicare contract. Please take a few minutes to complete a brief survey about our website.Community Health Plan of Washington (CHPW) uses a list of approved drugs. This document can assist medical providers in selecting clinically-appropriate and cost-effective products for their patients. Providing Washington State communities with affordable, quality health insurance, Community Health Plan of Washington is a not-for-profit organization, founded by local community health centers.