Prescription Drugs

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.

UDOH will continue to cover the following drugs:

• Hemophilia therapies
• Organ transplant immunosuppressants
• All mental health-related therapies including those involved in the treatment of attention deficit and hyperactivity disorders, anxiety, depression, psychotic disorders, seizure disorders, and substance use.

Here is how you can view or search the Formulary:

• To view or print a PDF of the Formulary, click here.
• To request a printed copy of the Formulary, call Member Services toll-free at 877-358-8797, Monday through Friday (except holidays), 6 a.m. – 6 p.m. TTY/TDD users can call 711.

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 at 877-358-8797 toll-free, Monday through Friday (except holidays), 6 a.m. – 6 p.m. TTY/TDD users can call 711. You may also contact us by email at HCUComments@HealthChoiceUtah.com. To view recent formulary changes, click here.

Opioid Prescribing Guidlines

Controlled Substance Prescribing and Monitoring

Utah state law now requires that providers check the Utah Department of Professional Licensing Controlled Substance Database (CSDB) prior to prescribing controlled substances to a patient for the first time. Prescription monitoring limits dispensing to patients seeking prescriptions from multiple prescribers and helps to identify patients who may be struggling with addiction. Providers and their staff can learn more about the program and apply here. Also, first-time controlled substance prescriptions are limited to a seven-day supply for individuals being treated for acute, nonsurgical pain.

Prescriber Education

Utah state law establishes the continuing education requirements for controlled substance prescribers under the Utah Controlled Substances Act.  It requires certain controlled substance prescribers to complete at least 3.5 hours of continuing education hours in one or more controlled substance prescribing classes as a requisite for license renewal.  In addition to other requirements, the controlled substance prescribing class should also include all elements of the FDA Blueprint for Prescriber Education under the FDA’s Extended-Release and Long-Acting Opioid Analgesics Risk Evaluation and Mitigation Strategy (REMS).

Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain

 The Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain (Guidelines) provide recommendations for the use of opioids for management of pain that are intended to balance the benefits of use against the risks to the individual and society, and to be useful to practitioners.

Requirements or Limits on Coverage

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

Prior Authorization

Health Choice may require prior authorization for certain drugs. Prior authorization will need to be obtained for medications noted with a “PA” in the drug list and for all unlisted medications. Providers need to get approval from Health Choice before prescriptions are filled. If approval is not obtained, Health Choice may not cover 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 may require 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 may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Health Choice will then cover Drug B. Please refer to the Health Choice Formulary to find out if a drug has additional requirements or limits. To view Step Therapy Coverage Policy, click here.

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