Formulary Updates Effective January 01, 2022
Date: 12/01/21
Effective 1/1/2022, Arizona Complete Health-Complete Care Plan (AzCH-CCP) will implement AHCCCS formulary changes based on the recommendations from the 10/18/2021 AHCCCS Pharmacy & Therapeutics (P & T) Committee.
Formulary changes are located on our website at: https://www.azcompletehealth.com/providers/pharmacy.html. We encourage all prescribing clinicians to review our Integrated Preferred Drug List (PDL) for preferred formulary alternatives prior to prescribing.
Highlights of the formulary changes effective 1/1/2022 are on the following page.
Please Contact Pharmacy Prior Authorization at 888-788-4408 x 6031278 if you have any questions.
Drug Class | Drug (s) Removed from Formulary | Preferred Alternative(s) on Formulary (NEW or current alternatives) | **Utilization Management (PA, STEP, QL, AGE) | *Grandfathering permitted (Y/N) |
Antimigraine Agents - Triptans
| Authorized Generic Zolmitriptan Tablet/ODT Zomig Nasal Spray | Zolmitriptan ODT Zolmitriptan Tablet Sumatriptan (SQ Kit/Tablet/Vial) Rizatriptan ODT/Tablet Naratriptan Tablet | QL | N |
Topical Steroids | N/A | Betamethasone Dipropionate Cream (NEW) Clobetasol Shampoo (NEW) | N/A | N |
HIV-AIDS
|
Edurant (oral)
| Delstrigo (NEW) Dovato (NEW) Efavirenz/Emtricitabine/ Tenofovir Disoproxil Fumarate (NEW) Isentress HD (NEW) Juluca (NEW) Norvir Powder Pack (NEW) Reyataz Powder Pack (NEW) Symtuza (NEW) Tivicay PD Suspension (NEW) | QL | Y |
Movement Disorders | Tetrabenazine Xenazine | Austedo (NEW) Ingrezza (NEW) | PA | Y |
Diabetic Meters, Continuous Glucose Meter (CGM)
| New Class | Dexcom G6 CGM System (ages 2 to < 4 years old) Freestyle Libre System (ages 14 and up) Freestyle Libre 2 System (ages 4 years old and up) | PA/ AGE | Patients on integrated systems only |
Opioid Antagonists | N/A | Kloxxado (NEW) Narcan Naltrexone tabs Vivitrol | N/A | N/A |
*AHCCCS P&T determines whether or not to permit grandfathering (continued use of a non-formulary medication). If grandfathering is not permitted, members will need to switch to the preferred formulary alternative and a new prescription may be required (See AHCCCS Policy 310-V).
**Prior Authorization (PA), Step Therapy (STEP), Quantity Limit (QL), Age Restriction (AGE), Authorized Generic (AG)