Health First Colorado Pharmacy Benefits Frequently Asked Questions

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.

• Contact the Colorado QuitLine at 1-800-QUIT-NOW (1-800-784-8669) for free coaching and support.
• Talk with your health care provider about the benefits and risks of taking smoking cessation medications while you are pregnant. Health Care Colorado covers two 90-day courses of smoking cessation medication with counseling to help you quit.

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.

Health First Colorado (Colorado’s Medicaid program) does not pay for vacation supplies.

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.

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 Magellan (1-800-424-5725) to request the replacement prescriptions. The replacement request and verification must be within 60 days of the last refill of the medication.

Health First Colorado (Colorado’s Medicaid Program) covers smoking cessation products (e.g. Chantix, nicotine patches and nicotine gum) with a prior authorization.

Learn more about how to Quit Smoking.

Beginning July 1, 2023 if your prescription is for a generic or brand name medication you will not have a co-pay.

Learn more about Health First Colorado Co-Pays.

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 or 303-894-2946.

Health First Colorado (Colorado’s Medicaid program) members have the option to get prescription medications through the mail. New or refill prescriptions for chronic conditions may be written for as much as a 100-day supply.

Please note that Health First Colorado does not pay for nor reimburse pharmacies for delivery fees. Additionally, delivery services are optional for each pharmacy.

How to get your prescription by mail:

• Ask your current pharmacy if they provide mail delivery for your prescription.
• If your local pharmacy does not provide mail delivery, but you want to stay local:
  • Use the Find a Doctor tool to find your nearest pharmacy.
  • Search your address in the “Find Providers Near Me” field, or click the “Find Me” button to search your location.
  • Adjust the “Within” tool to narrow the distance you are able to travel.
  • Use the “Find Providers by Type” drop down list to select “Pharmacy”.
  • Call other pharmacies in your area to ask about delivery options.
• If a local pharmacy does not offer mail delivery:
  • Use the Find a Doctor tool to find a pharmacy that may deliver.
  • Use the “Find Providers by Type” drop down list to select “Pharmacy”.
  • Scrolling out using the “-“ button on the bottom right hand side of the map to see other areas of the state, or a pharmacy out of state for a mail order pharmacy.

If you need more information, please contact the Pharmacy Liaison at 303-866-3588.

Diabetic supplies such as test strips, lancets and syringes are a covered medical benefit and not a pharmacy benefit. Please ask the pharmacy to bill DME-Supplies. Pharmacies can call 1-800-237-0757 if they require additional assistance billing supplies.

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.