Drug formulary (covered drugs)

To see our formulary, or list of covered drugs, choose your plan from the list below.

 

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 Colorado Federal Employees Health Benefits (FEHB) 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.

2024 Colorado Preferred Drug List - Spanish (PDF)

 

Medicare Part D formulary
Use this formulary if you have a Kaiser Permanente Medicare health plan.

 

 

Drugs that aren’t listed on the formulary, known as nonformulary drugs, aren’t covered by your plan. For nonformulary drugs, you have the following options:

  • You can pay full retail price for the prescription.
  • You can use your network pharmacy benefit, if applicable.
  • You can ask your doctor to prescribe a similar drug that’s included on our formulary.
  • You can ask your doctor to request an exception so your non-formulary drug can be covered by your prescription drug benefit.

The most effective way to get an exception to the formulary is to send a secure email to your doctor.

You can also call Member Services, Monday through Friday, 8 a.m. to 6 p.m., at:

1-303-338-3800
1-800-632-9700
TTY: 711
Or you can submit an online form.

 

 

Prior Authorization of Outpatient Prescription Drugs (for certain drugs, step therapies, age, provider, and quantity limits for the HMO lines of business):

Outpatient prescriptions drugs included on the drug formularies are covered, however certain drugs require authorization prior to being covered. To ensure that a drug is medically necessary and cost effective, members or their providers will need to get prior authorization for certain outpatient prescription drugs that are included on the drug formulary, as well as for all drugs that are not included on the drug formulary. Your provider should request prior authorization by completing and submitting the KPCO HMO Medication Request Form to the KPCO Pharmacy Authorization Service by faxing the form to 1-858-357-2615.

Find out which drugs are covered, and which ones require prior authorization by viewing the drug formularies at Covered drugs – Colorado/Kaiser Permanente The HMO drug formularies are based on the specific benefit plans, such as a Marketplace plan purchased on the exchange, a Federal Employee Health Benefit (FEHB), a large group employer HMO plan or an employer Self-Funded plan. Each formulary may have different limitations, restrictions, and rules for coverage.

To see what clinical criteria are required for a drug requiring prior authorization click here.

To see data regarding approvals and denials of prior authorization requests for outpatient prescription drugs click here.

 

 

For more information or to receive a copy of our drug formulary, please contact Member Services at one of the numbers below, Monday through Friday, from 8 a.m. to 6 p.m.:

Colorado Member Services
1-303-338-3800
1-800-632-9700
TTY: 711

You can also send a secure message to Member Services.

Please refer to your Evidence of Coverage for more information about your prescription drug coverage.