Medicaid PRIME: Update prior authorizations or prescriptions to continue member care
Beginning Jan. 1, 2024, you will be required to obtain prior authorization or you’ll need to issue new prescriptions for covered medications for members who started with Rocky Mountain Health Plans (Medicaid PRIME) and Child Health Plan Plus (CHP+) on or after July 1, 2022. Both plans previously covered medications listed on these transitioning members’ previous insurance preferred drug lists. We also previously covered medications that are not on members’ current preferred drug lists. These transition benefits are ending on Dec. 31, 2023.
What this means for you
You’ll need to issue a new prescription for a covered medication on members’ preferred drug lists. Or, you can obtain prior authorization approval to continue with members’ current treatment. We will no longer cover medications not on members’ current preferred drug lists without prior authorization. For a list of covered prescription drugs, go to our Pharmacy transitions update.