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

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.

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
October 1, 2019
July 1, 2019
April 1, 2019
January 1, 2019
November 15, 2018
October 1, 2018
July 1, 2018
April 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.

Member Appeal Rights

Appendix P - Prior Authorization Procedures and Criteria

Appendix P
October 1, 2019
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

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

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

Zolgensma