Clinical Prio Authorizations Title Image

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  
      Platinum  
      Gold  
      Silver  
      Bronze  

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 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
      Boniva
      Lidoderm Pain Patches
      Reclast/Bandronate
      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