State Payor Preferred Drug Lists or Formularies

Children's Health Insurance Program (CHIP)

CHIP Preferred Drug List (formulary) for the most commonly prescribed drugs.

The link is the CHIP Preferred Drug List of the most commonly prescribed drugs. It represents an abbreviated version of the drug list (formulary) that is at the core of your prescription-drug benefit plan. The list is not all-inclusive and does not guarantee coverage. Once again, questions concerning drugs covered by WVCHIP should be directed to Express Scripts, Inc. (ESI) at 1-877-256-4689.

Please understand that non-preferred drugs (prescription drugs NOT listed on the Preferred Drug List) will no longer be covered. If a provider (such as the patient's doctor) chooses to prescribe a drug not listed on the Preferred Drug List formulary it will be a 100% retail cost to the patient. Always ask the patient's doctor to use generic drugs whenever possible. Co-payments for drugs on the current PDL will remain the same. Questions by the patient or the patient's doctor concerning drugs covered by WVCHIP should be directed to Express Scripts, Inc. (ESI) at 1-877-256-4689.

Public Employees Insurance Agency (PEIA)

PEIA Preferred Drug List (formulary) for the most commonly prescribed drugs.

The following is a list of the most commonly prescribed drugs on the West Virginia Public Employees Insurance Agency (PEIA) preferred drug list. It is an abbreviated version of the drug list that is at the core of the PEIA pharmacy benefit plan. The list is not all-inclusive and does not guarantee coverage. In addition to using this list, you're encouraged to ask your doctor to prescribe generic drugs whenever possible.

This Preferred Drug List became effective on January 1, 2008 and is subject to change. This Preferred Drug List is to be used by those individuals who are covered by the West Virginia Public Employees Insurance Agency. Please direct your doctor and other healthcare providers to this Preferred Drug List for your prescriptions.

West Virginia AIDS Drug Assistance Program (WV ADAP)

ADAP Preferred Drug List (formulary) for the most commonly prescribed drugs.

WV ADAP assists in providing HIV-related prescription drugs to
underinsured and uninsured eligible individuals living with HIV/AIDS. This assistance is funded as a result of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act and by other sources of coverage including Medicaid, Medicare and private insurance. Applicants must apply for this assistance at their county office of the Department of Health and Human Resources.

Eligible West Virginians with HIV infection can obtain the drugs listed on the Preferred Drug List; however, all medications available in a generic drug must be dispensed as a generic drug.

West Virginia Medicaid

Medicaid Preferred Drug List (formulary) for the most commonly prescribed drugs.

Medicaid provides medical care in the community or in an institutional setting, such as a nursing home, to individuals who otherwise may not be able to afford the care. A variety of services are provided, according to state and federal guidelines, depending upon the individual or family circumstances. Recipients of Supplemental Security Income (SSI) automatically qualify for Medicaid. In addition, other individuals or families may apply for and receive Medicaid, if eligible and it is provided under a number of coverage groups. Medicaid is administered at the federal level by the Centers for Medicare and Medicaid Services (CMS) under the US Department of Health and Human Services.

There are many ways to qualify to receive Medicaid. Some of these coverage groups are mandatory ,i.e., required by Centers for Medicare and Medicaid Services (CMS)  to be provided by each state, and some are optional. With the combination of the mandatory and optional coverage groups, and those for which West Virginia has received waivers from federal requirements, West Virginia offers coverage to a wide range of groups.