Making Healthy Cheaper
Rx - Clinical Prior Authorizations

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:


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
      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