Pharmacy Resources

Rx Review Program

Participation Information

• Qualifications
• Application
• Orientation
• Questions and Answers

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

Counseling Session Forms

• Rx Review Client Counseling Pointers
• Rx Review Client Medication Table
• Provider Sample Letter and Consultation Summary

Billing Invoices

• Rx Review Pharmacist Invoice Form
  If interested in participating in this program please contact January.Montano@state.co.us

Prior Authorization Policies

Health First Colorado (Colorado's Medicaid Program) provides pharmaceutical benefits to Health First Colorado members. Some of these products require prior authorization approval.  All of the products subject to prior authorization are listed on the Preferred Drug List or Appendix P, both of which are listed below.

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.

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.

*New format of 7/1/18 PDL does not contain any content differences from the previous 7/1/18 PDL. The PDL classes listed alphabetically by organ/body system (I.-XI.). The “Control” + “F” function (search bar within document) can be used to find any drug or word listed in the document.

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.

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

Mail Order

Learn about Mail Order Prescriptions for Health First Colorado members.

Member Appeal Rights

Appendix P - Prior Authorization Procedures and Criteria

Hepatitis C Prior Authorization

• Hepatitis C Prior Authorization Request Form - Effective January 1, 2018 (Revised December 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.

• Global Prior Authorization Criteria
• Global Prior Authorization Form

Other Forms

• Pharmacy Prior Authorization Form
• Pharmacy Claim Form
• Other Coverage Code Quicksheet