Prescription Drugs

Your doctor may prescribe medication as part of your healthcare. It is important that you follow your doctor’s instructions and take the medication as your doctor has prescribed it.

You must have your prescription filled by a Health Choice Utah participating pharmacy. Click here to search for a participating pharmacy in your area in the Provider Directory.

Health Choice Utah provides a closed drug Formulary (medicine) benefit for its members. This means that if the drug is not in the Health Choice Formulary, Health Choice Utah must first approve the prescription drug before you can purchase it at the pharmacy.

About the Health Choice Utah Formulary

The Health Choice Utah Formulary is your guide to prescription drugs covered by Health Choice Utah. The Formulary is organized by sections. Each section includes therapeutic groups identified by either a drug class or disease state. Products are listed by generic name. Brand name products are included as a reference to assist in product recognition. Unless exceptions are noted, generally all dosage forms and strengths of the drug cited are covered. In addition, the formulary covers selected over-the-counter (OTC) products.

The Utah Department of Health (UDOH) covers the following drugs

• Hemophilia drugs
• Organ transplant immunosuppressants
• Mental health related drugs

For information or assistance with prescriptions covered by Utah Department of Health (UDOH), you may also contact:

Health Program Representative
(toll-free): 866-608-9422

Medicaid Information Line
(toll-free): 800-662-9651

Here is how you can view or search the Formulary:

To view or print a PDF of the Formulary, click here.

Health Choice may add or remove drugs from our formulary during the year. To get updated information about the drugs covered by Health Choice, call Member Services toll-free at 1-877-358-8797, Monday through Friday (except holidays), 6 a.m. – 6 p.m. TTY/TDD users can call 711.You may also contact us by e-mail at HCUComments@HealthChoiceUtah.com
To view recent formulary changes, click here.

Brand Name vs. Generic Drugs

Health Choice Utah covers both brand name and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug, but generic drugs usually cost less than brand name drugs. Generic drugs are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Prescription Drug Restrictions and Limits

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:

Prior Authorization: Health Choice Utah may require prior authorization for certain drugs. You will need to get approval from Health Choice Utah for drugs noted with a “PA” in the drug list or for any drugs not listed in the formulary. If you do not get approval, Health Choice Utah may not cover the cost of the drug. To view Prior Authorization Clinical Criteria, click here.

For your convenience, click here to obtain the Prior Authorization Form.

Quantity Limits: For certain drugs, Health Choice Utah may limit the amount of the drug that our plan will cover. For example, Health Choice Utah provides 30 units per 30 days of Zolpidem.

Step Therapy: In some cases, Health Choice Utah requires a member to try certain drugs to treat a medical condition before covering another drug for that condition. For example, if Drug A and Drug B both treat the medical condition, Health Choice Utah may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Health Choice Utah will then cover Drug B. Please refer to the Health Choice Utah Formulary to find out if a drug has additional requirements or limits. To view Step Therapy Coverage Policy, click here.

You can ask Health Choice Utah to make an exception to these restrictions or limits. For more information about prescription drug restrictions or limits, call Member Services toll-free at 1-877-358-8797, Monday through Friday (except holidays), 6 a.m. – 6 p.m. TTY/TDD users can call 711.