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Colorado Medicaid Prior (Rx) Authorization Form

Colorado Medicaid Prior (Rx) Authorization Form

Updated July 27, 2023

A Colorado Medicaid prior authorization form is used for members of the Medicaid program who wish to request a drug that is not on the preferred drug list (PDL). In order for a patient to receive non-preferred medication, the prescribing physician must fill out the prior authorization form, submit it to the Department of Health Care Policy & Financing, and await a reply. The Department will make a decision based on the physician’s medical reasoning and will only approve the medication if they agree with the medical justification. If the request form is denied, the patient has the option of either choosing a drug on the PDL or paying for the prescribed medication out of pocket.