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 https://www.express-scripts.com/DIAMOND Link
   Platinum https://www.express-scripts.com/PLATINUM Link
   Gold https://www.express-scripts.com/GOLD Link
   Silver https://www.express-scripts.com/SILVER Link
   Bronze https://www.express-scripts.com/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
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