Prior Authorization for Pharmacy

RMHP covers a wide variety of medications. The RMHP Formulary Guidelines include information about RMHP drug coverage. RMHP drug coverage is determined with active participation from the RMHP physician/pharmacist committee (Pharmacy and Therapeutics Committee).

RMHP Outpatient Formulary Guidelines:

  • Include the coverage level for drugs (whether prior authorization is required, copayment tier, quantity limits, etc.)
  • Encourage the use of appropriate generic drugs
  • Are updated monthly

Review the RMHP Outpatient Formulary Guidelines.

Prescription Drugs Requiring Prior Authorization from Pharmacy Department

Certain drugs must be prior authorized by the Pharmacy Department.   To request prior authorization, complete the appropriate prior authorization drug request form and fax to RMHP at 858-357-2538 or speak to a representative at 970-248-5031 or 800-641-8921.  Once all required information is received by us, your will receive your authorization decision within 48 hours.

Commercial and Medicaid drugs requiring prior authorization

Medicare Part D drugs requiring prior authorization

Prescription Drugs Requiring Step Therapy

Step therapy means another very similar drug must be tried first.  If this drug is not effective, or you can't tolerate it, then we will approve the drug you are requesting.

Medicare Prescription Drugs Requiring Step Therapy

Commercial and Medicaid Drugs Requiring Step Therapy