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. For Commercial and Medicaid members, fax to RMHP at 858-357-2538. For Part D members, send the fax to 858-790-7100. To speak to a representative call 970-248-5031 or 800-641-8921.  Once all required information is received by us, your will receive your authorization decision within 48 hours.

Electronic Pharmacy Prior Authorization Form

Medicare Part D Medication Request Form

Electronic Medicare Part D Medication Request Form

Commercial/Medicaid Forms

Commercial and Medicaid Prior Authorization Forms

Commercial and Medicaid Drugs Requiring Step Therapy

Commercial and Medicaid Prior Authorization Drug List

Medicare Forms

Medicare PART B Prior Authorization Forms

Medicare Prescription Drugs Requiring Step Therapy

Medicare Part D Prior Authorization Drug List