Pharmacy

pharmacy

Formulary and Drug Lists

The Kaiser Permanente formulary listings include brand name and generic medications, and notes which medications have restrictions on their prescribing.

 

2024 Colorado Marketplace Formulary (PDF)
For non-grandfathered small group plans purchased through Kaiser Permanente or Connect for Health Colorado, the insurance marketplace.

2024 Specialty Tier Drug List (PDF)
This list of specialty drugs applies to plans that follow the Colorado Marketplace Formulary.

2024 Colorado Specialty Pharmacy Info (PDF)
This lists information on where to obtain certain specialty drugs for members on a commercial plan.

2024 Preventive Tier Drug List (PDF)
This list of preventive drugs applies to any commercial plan that has chosen a benefit to allow preventive drugs to be offered at a reduced cost share to the member. Please refer to your prescription drug benefit plan details to determine if this benefit applies to you.

 


2024 Colorado Commercial HMO Formulary (PDF)
For mid or large group employer plans or a plan that is considered grandfathered.

2024 Specialty Tier Drug List (PDF)
This list of specialty drugs applies to plans that follow the Colorado Commercial HMO.

2024 Colorado Specialty Pharmacy Info (PDF)
This lists information on where to obtain certain specialty drugs for members on a commercial plan.

2024 Preventive Tier Drug List (PDF)
This list of preventive drugs applies to any commercial plan that has chosen a benefit to allow preventive drugs to be offered at a reduced cost share to the member. Please refer to your prescription drug benefit plan details to determine if this benefit applies to you.

 


2024 Colorado Marketplace Formulary (PDF)
For non-grandfathered small group plans purchased through Kaiser Permanente or Connect for Health Colorado, the insurance marketplace.

2024 Specialty Tier Drug List (PDF)
This list of specialty drugs applies to plans that follow the Colorado Commercial HMO.

2024 Colorado Specialty Pharmacy Info (PDF)
This lists information on where to obtain certain specialty drugs for members on a commercial plan.

2024 Preventive Tier Drug List (PDF)
This list of preventive drugs applies to any commercial plan that has chosen a benefit to allow preventive drugs to be offered at a reduced cost share to the member. Please refer to your prescription drug benefit plan details to determine if this benefit applies to you.

 

 

2024 Colorado CHP+ Formulary (PDF)
For those enrolled in Child Health Plan Plus (CHP+) Managed Medicaid plans.

 

 

2024 Federal Group Commercial Formulary (PDF)
For those enrolled in the Federal Employees Health Benefits (FEHB) plan.

2024 FEHB Prescription Drug Cost Lookup
Use this Drug Cost Look up tool if you are enrolled in the Federal Employees Health Benefits (FEHB) plan.

2024 Preventive Tier Drug List (PDF)
This list of preventive drugs applies to any commercial plan that has chosen a benefit to allow preventive drugs to be offered at a reduced cost share to the member. Please refer to your prescription drug benefit plan details to determine if this benefit applies to you.

2024 Colorado Specialty Pharmacy Info (PDF)
This lists information on where to obtain certain specialty drugs for members on a commercial plan.

 

2024 Colorado Self-Funded/Level-Funded/EPO Formulary (PDF)
For those enrolled in a Self-Funded or Level-Funded EPO plan.

2024 Colorado Level-Funded PPO/POS Formulary (PDF)
For those enrolled in a Level-Funded PPO or POS plan.

2024 Specialty Tier Drug List (PDF)
This list of specialty drugs applies to plans that follow the Colorado Self-Funded/Level-Funded/EPO Formulary.

2024 Preventive Tier Drug List (PDF)
This list of preventive drugs applies to any commercial plan that has chosen a benefit to allow preventive drugs to be offered at a reduced cost share to the member. Please refer to your prescription drug benefit plan details to determine if this benefit applies to you.

 

 

2024 Colorado Preferred Drug List (PDF)
For those enrolled in a Point of Service, Preferred Provider Organization, Choice Preferred Provider Organization or Choice Out of Area plan.

 

Medication Exception Process

Commercial

Medication Prior Authorization Requests

KPCO Pharmacy Authorization Guidelines

A coverage exception for a non-formulary or a restricted medication may be requested through one of the following:

Commercial benefit plans

Fax the commercial medication request form (MRF) to Kaiser Permanente

Medication Request form (MRF)

Medicare

Medicare benefit plans - EFFECTIVE 1/1/2021:

Fax the Medicare medication request form (MRF) to OptumRx at 1-844-403-1028

MEDICARE Medication Request form (MRF) (or)

Use SureScripts, within your electronic medical record (or)

Use CoverMyMeds - this can link to the same document as above (or)

Call OptumRx directly at: 1-888-791-7255, 8am to 8pm, 7 days a week.

 

Pharmacy Locations

Kaiser is an integrated care delivery model which includes pharmacy services in each of our medical offices. In addition, there are a few select network pharmacies that are also available to you under your pharmacy benefit to ensure you have adequate access to receive your prescription medications. To find a Kaiser medical office pharmacy or a network pharmacy that is available to you under your plan visit www.kp.org/locations