Drug Lists / Formularies

Use these tools to determine generic and brand name medications covered by Select Health for your patients:

• RxSelect is our larger drug list with up to five tiers of coverage.
• RxCore is a more cost-effective drug list with five tiers of coverage.
• Select Health Medicare is our drug list for members with Select Health Medicare coverage.* (See also Select Health Medicare Pharmacy Tools)
• Select Health Community Care is our drug list for members with Select Health Community Care (Managed Medicaid) coverage.

 

Drugs with Special Requirements

Access information on prescription and infusible drugs that require step therapy or preauthorization before they will be covered by the member's plan. Submit requests for preauthorization and access step therapy forms based on relevant member coverage. The links below are alphabetized lists of drugs with special requirements:

• Commercial Plans.
• Select Health Community Care.
• Select Health Medicare.
• View the guide: Drugs with Special Requirements: Using the Look-up Tool.
• Covered Diabetic Supplies for Colorado Option Plan.

Drug Preauthorization

• Use PromptPA for drug preauthorizations and exception requests for non-covered drugs.
• Learn more about PromptPA.

 

Colorado prescribers may also use the statutory Uniform Pharmacy Prior Authorization Request form**, the Colorado Standard Exception Form for Contraceptive Products, or the Colorado Serious Mental Illness Step Therapy Exception form. Nevada prescribers may also use the Nevada Standard Exception Form for Contraceptive Products. However, for faster, more convenient service, we encourage all providers to submit electronically through PromptPA. 

 

Specialty Drugs

Access additional resources for prescribing specialty drugs:

• Intermountain Specialty Pharmacy.
• Intermountain Homecare – Infusion Therapy.
• Walgreens Specialty Pharmacy.

* Select Health, as a provider of Medicare Part D, is required to give sufficient notice to all affected parties (including pharmacies, State Pharmaceutical Assistance Programs, physicians, and pharmacists) whenever a negative formulary change is made. The negative formulary change communication notifies an affected party that information is frequently posted to our website regarding upcoming formulary changes. Select Health updates this formulary monthly (as directed by CMS). In this process, we may make negative changes to accommodate new generics coming to the market as well as other market changes. Changes will be posted at least 30 days before the formulary changes go into effect. Patients affected by the formulary changes will be sent a written change notice at least 30 days before the change goes into effect. Questions? Please contact Select Health at 855-442-9988. View latest Medicare Advantage formulary changes.

**Colorado Prescribers: If additional information is required to process an urgent or non-urgent preauthorization request, the prescribing provider shall submit the information requested by the carrier within two (2) business days of receiving a request for additional information from Select Health or Scripius.  A preauthorization request will be deemed approved when criteria are met or turnaround time lapses. A request will be deemed denied when clinical criteria are not met or when additional request information cannot be obtained within the regulatory requirements.