Professionally Administered Medication - Individual & Family Plan - by CHPW

Community Health Plan of Washington (CHPW) requires prior authorization and formulary exception for certain professionally administered medications

These professionally administered drugs require prior authorization. Review CHPW’s Clinical Coverage Criteria for these drugs. For medications that are listed as requiring prior authorization but do not have CHPW Clinical Coverage Criteria, MCG guidelines will be used to determine medical necessity.

Submitting a prior authorization request for professionally administered drugs

ONLINE (preferred) through the Care Management Portal (JIVA)
Request a Care Management Portal account to check eligibility and authorization status, print approval letters, and submit requests online 24/7.

Fax: Fill out the Prior Authorization Request Form and fax it, with supporting documentation, to the number listed on the form
Please contact CHPW with any questions or concerns.

Professionally administered medication requiring prior authorization and formulary exception

➔ Prior Authorization List and Professionally Administered Medications


Required Training

Providers are required to complete a Fraud, Waste, and Abuse training within 90 days of contracting with CHPW and annually thereafter. All clinic staff – including CEOs, senior leaders, managers, clerical/admin staff, physicians, and other clinical staff – are required to receive this training. Training courses are available on the CMS Medicare Learning Network website.

More information can be found in our Provider Manual.