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
- 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 shila.schrage@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.
Click to view the Pharmacy Prior Authorization webinar (a review of Pharmacy Prior Authorization and Hepatitis C Prior Authorization request information).
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 |
|---|
| July 1, 2019 |
| April 1, 2019 |
| January 1, 2019 |
| November 15, 2018 |
| October 1, 2018 |
| July 1, 2018 |
| April 1, 2018 |
| January 1, 2018 |
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.
Appendix P - Prior Authorization Procedures and Criteria
| Appendix P |
|---|
| July 1, 2019 |
| April 1, 2019 |
| January 1, 2019 |
| November 15, 2018 |
| October 1, 2018 |
| July 1, 2018 |
| May 29, 2018 |
| May 1, 2018 |
| April 1, 2018 |
| January 1, 2018 |
Hepatitis C Prior Authorization
- Hepatitis C Prior Authorization Request Form - Effective August 1, 2019 (Revised July 2019)
- Hepatitis C Prior Authorization Request Form - Effective January 1, 2019 (Revised December 2018)
- 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.
Other Forms
- Drugs Covered by Medicaid for Medicare-Medicaid (Dual Eligible) Members
- Pharmacy Prior Authorization Form
- Pharmacy Claim Form
- Other Coverage Code Quicksheet
- Request for 340B Acquisition
Pharmacist OTC Prescriptive Authority List
This document contains the drugs that pharmacists may prescribe to members once enrolled with Health First Colorado.
OTC Prescriptive Authority List
For more information specific to pharmacist enrollment, please see the Pharmacist Enrollment: Over-the-Counter and Immunizations page.
340B Policy and Procedures Manual
This document contains the Health First Colorado policies and procedures for Managed Care Organization and Fee-for-Service providers who participate in the 340B Drug Pricing Program. This guidance applies to prescription drugs dispensed in an outpatient setting (i.e., pharmacy) and drugs administered in a physician’s office or clinic. This guidance does not apply to prescription drugs provided in an inpatient or outpatient hospital setting.
340B Policy and Procedures Manual
Nusinersen (Spinraza)
Coverage Standards and Request Form