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Prior Authorization - Pharmacy

Prior Authorization - 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).


About Prior Authorization for Pharmacy

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

View our drug formularies

Download formulary changes for the Good Health formulary

Download formulary changes for the RMHP Prime and CHP+ formulary

Certain drugs must be prior authorized by the Pharmacy Department. To request prior authorization, please complete and submit the below form. You may also contact a representative at 970-248-5031 or 800-641-8921. When all required information is received by us, you will be notified of the authorization decision within 48 hours.

Submit an electronic prior authorization request

Download Good Health prior authorization drug list

Download Good Health drugs requiring step therapy

Download RMHP Prime and CHP+ prior authorization drug list

Download RMHP Prime and CHP+ drugs requiring step therapy

Download RMHP Advantage Four-Tier prior authorization drug list

Download RMHP Advantage Four-Tier drugs requiring step therapy

View printable RMHP Advantage Four-Tier prior auth drugs

View printable Good Health prior auth drugs

View printable RMHP Prime and CHP+ prior auth drugs

View printable Medicare Part B prior auth drugs

View printable Formulary Exception Request Form

View RMHP DualCare Plus requiring step therapy

View RMHP DualCare Plus prior auth drug list