Medicaid Pharmacy Benefits
Find answers to our Medicaid Pharmacy Benefit Frequently Asked Questions (FAQs)
Learn about Mail Order Prescriptions
What is a Preferred Drug List (PDL)?
Colorado Medicaid’s Preferred Drug List of clinically effective medications that you can get without needing prior authorization or approval. This list is updated regularly.
You may still be able to get drugs not on the Preferred Drug List. To get drugs not on the Preferred Drug List, your provider will need to get prior authorization from Colorado Medicaid.
If you are already taking a drug not on the Preferred Drug List or your drugs gets removed from the Preferred Drug List, you may be able to keep taking the same drug. Talk to your provider about staying on your same drug.
What is a Prior Authorization (PA) and how do I get one?
Your provider will submit the prior authorization request for you. After your prior authorization request is reviewed you and your provider will find out Colorado Medicaid’s decision.
If the criteria are not met, the doctor can re-submit with updated information, or appeal the decision to Medicaid’s Pharmacy Benefits section for further review.
Each request is processed within 24 hours, and most phone requests are given the approval/denial decision immediately upon submission.
If you have an emergency, your provider can get a 72-hour emergency supply of the drug you need.
How to Read the Preferred Drug List
This is the Preferred Drug List. Drugs in the Preferred column do not require prior authorization. Drugs in the Non-preferred column require prior authorization.
Are some drugs not covered at all?
Colorado Medicaid does not cover the following categories of medications for any reason:
- Non-Rebatable Drugs
- Fertility Drugs
- DESI Drugs
- Cosmetic Drugs
- Weight-Loss Drugs
Are there quantity limits to some drugs?
Yes, some drugs may have limits to how many you can get. The drugs listed below have limits to how many you can get.
|MULTIPLE SCLEROSIS AGENTS|
|OPIOIDS Long Acting – Oral Opioids|
|Oxycontin||Opana ER||Nucynta ER|
|PROTON PUMP INHIBITORS|
|SKELETAL MUSCLE RELAXANTS|
|STIMULANTS and ADHD|
|Amerge||Axert||Frova||Imitrex & injection||Imitrex nasal spray||Imitrex|
|Relpax||Treximet||Zomig nasal spray||Zomig|
How much are co-payments for drugs?
- Brand Name Medications: $3
- Generic Medications: $1
- Clients 18 and under, pregnant women (including 60 days after delivery) and clients residing in a nursing home: $0
For more information about the Colorado Medicaid Pharmacy Benefits contact the Medicaid Customer Contact Center.
Learn about Prescription Drug Discount Resources.