800 468 5744 healthplan@opehw1.com Mon - Fri: 8am - 5pm
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
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