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Clinical Prior Authorization (CPA)
Prescription Management Program

Certain prescription medications require a Clinical Prior Authorization (CPA) approval from the OPEH&W Health Plan before they will be covered. Types of Clinical Prior Authorizations (CPA's) include, but are not limited to, medications with quantity limitations, age limitations, and/or those requiring clinical determinations for appropriate use. The OPEH&W Health Plan’s prescription vendor administers the Clinical Prior Authorization (CPA) process on behalf of the OPEH&W Health Plan.

Use the following links to access the Express Scripts (ESI) Formulary for each health coverage option:
   Diamond Link
   Platinum Link
   Gold Link
   Silver Link
   Bronze Link
The OPEH&W Health Plan reserves the right to adjust this list from time to time as required
If in doubt, contact the Health Plan Administration Office to verify whether a covered medication is subject to Exclusion

Clinical Prior Authorization (CPA) Medications:
Acne Medications (Oral & Topical) such as Tretinoins (Retin A) & Claravis for ages 25 and older
Anabolic Steroids such as Nandrolone, Oxandrolone & Winstrol
Anti-Abuse Drugs such as Suboxone
Anti-Diabetic Injectables such as Byetta
Benign Prostatic Hyperplasia (BPH) Agents such as Cialis
Lidoderm Pain Patches
Botulinums such as Botox
Growth Hormones
Narcolepsy Drugs such as Mondafinil (generic for Provigil)
Omega-3-Acid Ethyl Esters such as Lovaza
Opioids (Short-Acting) such as Actiq
Progesterone Support such as Crinone 8%
All Specialty Pharmacy Drugs