If you need mental health and/or substance use disorder services, contact your Regional Organization.
What is my Case Number and where do I find it?
Your Case Number is how we identify you and members of your household in our system. Your Case Number starts with “1B.” This number is used by programs such as Health First Colorado (Colorado’s Medicaid Program), Food Assistance, Cash Assistance and/or Colorado Works to identify you. It is shown on all letters we send you. You can view any letters sent from the State (also known as client correspondence) in the Mail Center of your PEAK account.
If you do not qualify for Health First Colorado, you have other coverage options. You will need your Case Number to find out if you qualify for financial assistance to help buy private health insurance through Connect for Health Colorado.
I am covered by Medicare and Health First Colorado. Why is Health First Colorado not paying for my prescriptions?
Once a Health First Colorado (Colorado’s Medicaid program) member is entitled to receive Medicare, Medicare Part D will cover most of your prescriptions. Health First Colorado will only pay for a few medications that are excluded by your Part D plan. If you need assistance to find and enroll on a Part D plan, please call 1-888-696-7213.
Can I request an early refill if my medication was lost or stolen?
Health First Colorado (Colorado’s Medicaid Program) will cover lost, stolen or damaged medications once per lifetime for each member. Pharmacies must call for overrides for lost, stolen, or damaged prescriptions. Please call your pharmacy and they will need to call Prime (1-800-424-5725) to request the replacement prescriptions.
Are over-the-counter (OTC) medications covered?
Select over-the-counter (OTC) medications are covered. For an up-to-date list of covered OTC medications, go to Pharmacy Resources: Appendix P and search for the “OTC Products” section. You can also ask your provider or your pharmacist what OTC medications are covered.
Can I get the name brand medication when a generic is available?
Through scientific testing, the Food and Drug Administration (FDA) ensures that generic drugs are safe and effective, contain the same active ingredient and work the same way as the brand name. Health First Colorado (Colorado’s Medicaid Program) can pay for a name brand drug if a generic is not available, if your doctor considers the name brand to be medically necessary or if the medication is excluded from the generic mandate (e.g., medications for mental illness, cancer, epilepsy and HIV/AIDS). In cases where your doctor would like you to have the brand name when a generic is available, a prior authorization will need to be completed by your doctor and the prior authorization must be approved by Health First Colorado before you will be allowed to receive the brand name.
My pharmacy told me my medication is denied because a prior authorization was needed. What should I do?
Some medications require your doctor to file a prior authorization request before a medication will be covered. Please ask your doctor to contact Health First Colorado (Colorado’s Medicaid program) at 1-800-424-5725 to request a prior authorization for your medication. Once the prior authorization is submitted, it will take up to 24 hours to process.
My pharmacy told me my diabetic supplies are not covered. Is that true?
Diabetic supplies such as test strips, lancets and syringes are a covered medical benefit and not a pharmacy benefit. The exception is Continuous Glucose Monitors (CGMs) which may be billed under the pharmacy benefit or the medical benefit. Pharmacies can call 1-800-424-5725 for additional assistance billing CGMs under the pharmacy benefit. For other diabetic testing supplies, and for assistance billing medical claims, pharmacies may call 1-833-468-0362.
Can I get my medications early if I am going on vacation?
Health First Colorado (Colorado’s Medicaid program) does not pay for vacation supplies.
Can I get my medication early?
Early refills are covered when there is an increase in dosage or if a client is going into or leaving a nursing home. Clients may receive up to a 100 day supply of maintenance medications and up to a 30 day supply of non-maintenance medications. If you run out of medication, contact your doctor and discuss adjusting your prescription to your current needs.