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.
Requirements or Limits on Coverage
Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:
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.
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.
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
Medicaid Information Line
Formulary Adds and Deletions
Prior Authorization Criteria
Step Therapy Policy
HCU Preferred Drugs List
Synagis Authorization Form 2016-2017
Updates Regarding Our Pharmacy Benefits Manager (PBM) Effective January 1, 2015
For information and assistance with prescription drugs, call toll-free: 877-358-8797
For information about prescription drugs covered by UDOH, visit the UDOH website:
Utah Medicaid Pharmacy Website