Your PCMP will write your prescriptions if you need medicine. Most prescription drugs are covered. Medicaid has a preferred drug list (PDL), but drugs not on the list may be covered if your PCMP gets approved to use them. Generic drugs are prescribed unless the doctor thinks that a brand name drug is needed to treat your condition. In that case, the doctor will need to get prior approval.
You will get your medicines from a Medicaid approved pharmacy. Some PCMPs have a pharmacy on site. In that case, you will get your medicines from the pharmacy in your PCMP's clinic.
If your PCMP does not have a pharmacy on site, you will have to get your prescriptions filled at an approved drug store.
Drugs that are not covered under Medicaid
- Cosmetic products. For example: hair removal, hair growth products, or skin blemish creams.
- Fertility drugs – medicines to help you get pregnant.
- Medicines used for research that are not approved by the Food and Drug Administration (FDA).
- Medicines that are not medically necessary.
- Erectile dysfunction drugs (Viagra, Levitra and Cialis).
- Herbal supplements.
- Stop-smoking products. Other stops-smoking help may be available.
- For more information on a free program to quit smoking, please visit the Colorado quit line
Colorado Prescription Drug Program
The State of Colorado has a Preferred Drug List (PDL) for Medicaid members who need prescription medication. The PDL is a list of drugs that do not need approval. Your PCMP can prescribe drugs on this list without an approval from the state. If a drug is not on this list your PCMP will need approval from the state before he/she can prescribe it. This means that some drug choices are limited.
You can get more information about the PDL and any future changes by:
- Going to the state website
- Calling the state Pharmacy Liaison at 303-866-3583, 1-800-866-3513, or
- Calling your PCMP