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Prior Authorization Policies

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. 

Appendix P- Prior Authorization Procedure and Criteria

Effective April 01, 2014

Effective January 01, 2014

Effective October 01, 2013

Effective July 01, 2013

Effective January 01, 2013

 

 Prior Authorization Form

Prior Authorization Form

 

Hepatitis C Prior Authorization

Sovaldi

Victrelis 

Drug Quantity Limits

Effective January 15, 2012

Effective April 1, 2009

 

Global Prior Authorization
The Global Prior Authorization policy was developed 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.

Global Prior Authorization Criteria

Global Prior Authorization Form