Colorado Prescription Drug Services
RMHP offers many great services to support you in prescribing the most appropriate, cost effective medications for your patients. Learn more about these services and access detailed RMHP formulary and pharmacy provider information here.
Pharmaceutical Management Procedures
Request prior authorization for drugs:
You will find criteria for each drug, as well as the RMHP Coverage Policy by clicking on one of the links listed below. Locate the PDF file for the drug you wish to prior authorize, complete the criteria form and fax it to the RMHP Pharmacy Help Desk. For Commercial and Medicaid members, fax to 858-357-2538.
For Medicare Part D members, fax to 858-790-7100.
For Commercial, Medicaid, CHP+ or Exchange:
Electronic Pharmacy Prior Authorization Form
Drug Specific Prior Authorization Forms - Commercial and Medicaid
For Medicare and PERA:
Medicare Part D Medication Request Form
Electronic Medicare Part D Medication Request Form
Drug Specific Prior Authorization Forms - Medicare Part B
Drugs that require Prior Authorization for Medicare Part D
Request coverage of Non-Formulary drugs:
Validate that the drug you are requesting a Formulary Exception for is not included on a formulary by clicking on the appropriate formulary links below. If the drug is not included on the formulary, please print and complete the appropriate exception form and fax it to the RMHP Pharmacy Help Desk. For Commercial and Medicaid members, fax to 858-357-2538.
For Medicare Part D members, fax the form to 858-790-7100.
Good Health Commercial Formulary
Commercial Formulary Exception Request Form
Medicare Part D Premier Formulary
Medicare Part D Formulary Exception Request Form
Determine which drugs require Step Therapies:
Drugs requiring Step Therapy are included in the formulary as ST. Drugs designated as ST will be flagged in the formulary with the required alternative drug(s). A therapeutic trial of a drug must be used prior to coverage of a drug that requires Step Therapy.
Commercial/Medicaid Step Therapy List
Medicare Part D Step Therapy List
Determine which drugs have quantity limits:
Drugs that have quantity limits are identified in the formularies with a QL (quantity/days supply).
For a complete list of all Formulary Policy Indicators, please go to the Good Health Commercial Formulary or the Medicare Part D Formulary.
Brand Name Drug Requests:
If you get a brand name drug when there is a generic version available, you must pay the difference between the cost of the brand name and the generic version, in addition to your copayment.
To request removal of this additional cost, a Brand Name Drug Request form must be completed along with a MedWatch form and faxed to the RMHP Pharmacy Help Desk at 858-357-2538. This applies to Members using our Medicaid, CHP+ and Legacy formularies.
Epocrates Handheld Drug Database
This convenient, handheld drug database has clinical information for almost 3,000 drugs. Using Epocrates you can look up:
- Adult and pediatric dosing
- Side effects and interactions
- Drug costs
- Generic or lower-cost alternatives
Easy access to this information not only saves you time, it helps reduce the chance of prescribing errors, frustration with insurance formularies, delays, pharmacist call-backs, and unexpected costs. You can download Epocrates Rx FREE or you can select an enhanced version at the subscription rate.
WellDyneRx Mail Service Pharmacy
- Log onto myWDRX.com to request a refill online or check the status of an order or call WellDyneRx at 888-479-2000 to place an order by phone
Drug Information and Formularies Detailed formularies Formulary Updates Medicare Part D Formulary changes Pharmacy Resources Rocky Mountain MedImpact Payer Sheet Summary 2015 NCPDP Version D.o Payer Information Commercial, CHP+, Medicaid, and Exchange Plans NCPDP Version D.o Payer Information Medicare D Plans CMS Notice of Appeal Rights