Pharmacy Resources

Rx Review Program

Participation Information

State of Colorado Medical Assistance Program state plan for Medication Therapy Counseling, Supplement to Attachment 3.1-A, section 6.d.

Counseling Session Forms

Billing Invoices

Preferred Drug List (PDL)

The PDL is developed based on safety, effectiveness, and clinical outcomes from classes of medications where there are multiple drug alternatives available and supplemental rebates from drug companies, allowing Colorado the ability to provide medications at the lowest possible costs.

Current PDL
October 1, 2017
July 1, 2017
April 1, 2017
January 1, 2017
October 1, 2016
July 1, 2016
April 1, 2016
March 1, 2016
January 1, 2016

PDL Supplemental Documents

PDL Stimulant Class Diagnosis Table is a list of medications in the Stimulants and related agent PDL class. It includes medication’s ages and diagnoses which may be covered by Colorado Medicaid. It is to be used in conjunction with the Stimulants and related agent section PDL.

Please visit the Pharmacy and Therapeutics (P&T) Committee page for more information.

Manufacturer Information

Preferred Drug List Drug Class Announcements are sent via email at least 45 days prior to each P&T Committee Meeting review. Supplemental rebate offers should be submitted to Provider Synergies / Magellan Rx Health here.

For manufacturer presentations, please see P&T Policies and Procedures.

Mail Order

Learn about Mail Order Prescriptions for Health First Colorado members.

Prior Authorization Policies

Health First Colorado (Colorado's Medicaid Program) has established an extensive formulary in order to provide pharmaceutical benefits to Health First Colorado members. 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.  

Note: A provider can submit a request either by phone or by fax to Health First Colorado’s Prior Authorization Helpdesk.  The Helpdesk phone number is 1-800-424-5725 and the fax number is 1-800-424-5881. It is open 24 hours a day, seven days a week.

Member Appeal Rights

Appendix P - Prior Authorization Procedures and Criteria

Appendix P
November 1, 2017
October 1, 2017
August 1, 2017
July 1, 2017
April 1, 2017
January 1, 2017
October 1, 2016
July 1, 2016
April 1, 2016
February 17, 2016
January 1, 2016

Hepatitis C Prior Authorization

Hepatitis C Prior Authorization Request Form - Effective October 1, 2016 (Revised May 2017)

Hepatitis C Treatment Outcomes

 

Global Prior Authorization

The Global Prior Authorization policy was developed to protect the health of Health First Colorado's most vulnerable members. Members 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.

Medicaid Covered Drugs for Medicare-Medicaid Eligible Members

Other Forms