About RMHP Prescription Drug Coverage and Drug Prior Authorization

Whether you have a one-time illness or a chronic condition, RMHP knows the proper treatment and medication is of the highest importance. Read on to learn more about what we offer with our prescription coverage.  If you still have questions, we're happy to help.

For members needing assistance, please call the Member Services number on your ID card.

Drug Formularies

RMHP Drug Formularies provide helpful information about your prescription drug coverage, including:

• Copayment tiers
• Quantity limits for medications (if applicable)
• Prior authorization requirements for medications (if applicable)
• Drugs that are not covered
• Drugs that may be subject to special Affordable Care Act coverage

View our drug formularies

Prior Authorization

Certain drugs must be prior authorized. To request prior authorization, please see the resources below. To contact a representative, please call the Provider number on the member’s ID card..

Requesting a Pharmacy or Formulary prior authorization

Select from the resources below to request authorization for a drug obtained through a pharmacy. Drugs on formularies are typically self-administered and provided by an in-network retail or mail order pharmacy.

(please note, by clicking this link, you will be leaving RMHP.org)

Submit a pharmacy drug prior authorization request online

View printable Medicaid and CHP+ pharmacy drug criteria

View printable Individual and Family Plan pharmacy drug criteria

Requesting a Medical or Physician administered drug

Medical or out-patient drugs are those that are administered by a physician. These drugs do not originate from a pharmacy, since they are provided by the physician and are not self-administered. Some medical drugs require prior authorization. Select from the resources below to request authorization for a medical drug.

Submit a request for an Individual and Family Plan Medical Drug online

Submit a Coverage Exception Request for a Medical Drug

View printable RMHP Prime and CHP+ prior auth drugs

View printable Individual and Family Plan Medical prior auth drugs