800 468 5744 healthplan@opehw1.com Mon - Fri: 8am - 5pm
Certain medications require Prior Authorization approval from the OPEH&W Health Plan before they will be covered. Types of Prior Authorizations include, but are not limited to, medications which exceed recommended quantity limitations, exceed recommended age limitations, and/or require clinical determinations for appropriate use. The OPEH&W Health Plan’s prescription vendor administers the Quantity & Age Limitation 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 a Quantity or Age Restriction.
Quantity or Age Restriction Medications
Acne Medications (Topical) such as:
Tretinoins (Retin A) for ages 26 and older
Analgesics (Opioids) such as:
Oxycontin
Anaphylaxis Therapy such as:
Epipen
Antiemetics such as:
Emend
Anti-fungal Agents such as:
Lamisil
Blood Glucose Monitoring Devices such as:
Glucometers - One Per Year
Compounds, up to $300 Maximum Limit Per Script
Influenza Agents such as:
Tamiflu
Insomnia Hypnotics or Sleep Aids such as:
Zolpidem (generic name for Ambien)
Migraine Agents such as:
Sumatriptan (generic name for Imitrex)
Non-Steroidal Anti-Inflammatory Drugs such as:
Keterolac (generic name for Toradol)
Tobacco Cessation such as:
Chantix
Bupropion (generic name for Zyban)
Gum - Over-The-Counter
Requires a prescription
Limited to 2 sessions or 180 days per year
E-Cigarettes, Nasal sprays or inhalers used for tobacco cessation are excluded