The Colorado Medicaid program has established an extensive formulary in order to provide pharmaceutical benefits to Medicaid clients.  In order for a provider to prescribe a drug that is not on this established list, the provider must receive an approval on a prior authorization request from the Department. 

Medical Food Policy

Effective July 1, 2009, the Department will no longer allow prior authorizations for products classified as a medical food.  According to US CODE: Title 42, 1396r-8 and Code of Colorado Regulations 10 CCR 2505-10 8.800, medical foods are not allowed as pharmacy benefits for the Medical Assistance Program.  For a list of products deemed a medical food, please review Appendix Y.

Global Prior Authorization

The Global Prior Authorization policy became effective on June 1, 2009, to protect the health of Medicaid's most vulnerable clients.  Clients who qualify will be exempt for one year from prior authorization requirements for non-preferred drugs.  They will also be exempt from prior authorization requirements for non-PDL drugs currently requiring prior authorization.  Clients who do not qualify for a Global Prior Authorization may still be eligible for prior authorizations for individual drugs.