Denver-Health-Medical-Plan policy updates
Track new and updated Denver-Health-Medical-Plan policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Gastrointestinal disorders — Ulcer disease drug formulary updates | Denver-Health-Medical-Plan | Clinical | Gastroenterology | Modified | Jan 1, 2026 |
| Prior Authorization Requirements — Specialty Pharmacy and Related Supplies | Denver-Health-Medical-Plan | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| Prior authorization requirements for specialty drugs | Denver-Health-Medical-Plan | Clinical | Pharmacy & Specialty Drugs | Modified | Dec 1, 2025 |
| Step Therapy Requirements — Part 1 (select drugs; Step 2 prior-therapy rules) | Denver-Health-Medical-Plan | Clinical | Pharmacy & Specialty Drugs | Modified | Dec 1, 2025 |
| Formulary and Prior Authorization Guidelines for Outpatient Drugs | Denver-Health-Medical-Plan | Clinical | Pharmacy & Specialty Drugs | Modified | Oct 1, 2025 |
| Behavioral health code set billing for Elevate Medicaid Choice | Denver-Health-Medical-Plan | Reimbursement | — | Modified | Jul 1, 2025 |
| UNIFORM PHARMACY PRIOR AUTHORIZATION REQUEST FORM | Denver-Health-Medical-Plan | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2020 |
| Breast pumps for mothers of newborns | Denver-Health-Medical-Plan | Administrative | — | Modified | — |
| Access to Service Standards | Denver-Health-Medical-Plan | Administrative | — | Modified | — |
| Programa de Asequibilidad del Autoinyector de Epinefrina | Denver-Health-Medical-Plan | Administrative | — | Modified | — |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
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Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.