Health First Colorado Pharmacy Benefits

What is a Preferred Drug List (PDL)?

The Health First Colorado (Colorado's Medicaid program) Preferred Drug List includes 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 that are not preferred on the Preferred Drug List, your provider will need to get prior authorization from Health First Colorado.

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?

A Prior Authorization is a request from your provider for Health First Colorado to cover a drug not listed on the Preferred Drug List or otherwise listed on Appendix P of the Preferred Drug List. Your provider will submit the prior authorization request for you. After your prior authorization request is reviewed you and your provider will find out Health First Colorado's decision. If the criteria are not met, the doctor can re-submit with updated information, or appeal the decision to Health First Colorado's Pharmacy Benefits section for further review. Members with a serious or complex medical condition may qualify for an exception to step-therapy requirements for medications used to treat their serious or complex medical condition. Serious or complex medical condition means the following medical conditions: serious mental illness, cancer, epilepsy, multiple sclerosis, or human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS), or a condition requiring medical treatment to avoid death, hospitalization, or a worsening or advancing of disease progression resulting in significant harm or disability. Your provider can submit this request for you.

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.

Colorado Pharmacy Call Center phone number: 800-424-5725 | Colorado Pharmacy Call Center Fax Number: 800-424-5881

Electronic Prior Authorization (ePA): Real Time Prior Authorization via Electronic Health Record (EHR)

How to Read the Preferred Drug List

Most drugs in the Preferred column of the Preferred Drug List do not require prior authorization. Drugs in the Non-preferred column require prior authorization.

Are some drugs not covered at all?

Health First Colorado does not cover the following categories of medications for any reason:

  • Non-Rebatable Drugs
  • Fertility Drugs
  • Drug Efficacy Study Implementation (DESI) Drugs
  • Cosmetic Drugs
  • Weight-Loss Drugs
  • Sexual or Erectile Dysfunction Drugs

What are the co-pays for drugs?

  • Beginning 7/1/2023, Health First Colorado Members do not have co-pays for drugs.
  • Please refer to the Member Handbook for more information.

For more information about the Health First Colorado Pharmacy Benefits contact the Member Contact Center.

Learn about Prescription Drug Discount Resources.