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.

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.

Current PDL
July 1, 2018*
April 1, 2018
January 1, 2018
October 1, 2017
July 1, 2017
April 1, 2017
January 1, 2017

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.

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
July 1, 2018
May 29, 2018
May 1, 2018
April 1, 2018
January 1, 2018
December 1, 2017
November 1, 2017
October 1, 2017
August 1, 2017
July 1, 2017
April 1, 2017
January 1, 2017

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