Check here for Information about CHP's Commercial and Medicare Formularies, Utilization Management Criteria, Pharmacy Network, and safe medication practices.
Capital Health Plan has developed a short training video to explain how a prior authorization request to Prime for medications that process at the pharmacy by clicking here.
Medications Obtained Through the Pharmacy Benefit (member will get the drug from a retail, mail order, specialty or other pharmacy).
For those drugs that process through the member's pharmacy benefit (e.g. the use of a retail, mail order, specialty or other pharmacy), please refer to the formulary documents below to determine if a prior authorization is needed and submit request directly to Prime.
Choose the appropriate Plan below for Formularies, Criteria and Forms:
Choose the appropriate Plan below for Electronic Forms for Medications obtained through the pharmacy:
Medications Obtained Through the Medical Benefit (Prescriber office or facility will supply the drug, administer it to the member and then bill CHP)
For those drugs that process through the Medical benefit, (Prescriber office or facility will supply the drug, administer it to the member and then bill CHP), please refer to the documents below for a list of drugs that require prior authorization and submit request directly to CHP.
Medications obtained through the Medical Benefit (pdf 13.12 kB). Note: The table is updated on a regular basis please review for the most current information. The codes in the table are for informational purposes only and maybe updated as new codes are identified for the drugs listed.
Request form for medications obtained through the medical benefit.
- Medication Prior Authorization Request Form (pdf 254.55 kB) to be used only for requests when the Prescriber office or facility will supply the drug, administer it to the member and then bill CHP.
Please note Capital Health Plan does not administer the Pharmacy benefits for most State of Florida Commercial members, which has been in place since January 1, 2012.