Formulary Updates Effective 9/1/2024

Date: 07/25/24

Formulary Updates Effective 9/1/2024

Effective  September  1,  2024,  Arizona  Complete  Health-Complete  Care  Plan  (AzCH-CCP)  and  Care1st  will implement  AHCCCS  formulary changes  based on  the  recommendations  from  the  June  18,  2024,  AHCCCS Pharmacy & Therapeutics (P & T) Committee.  

To  review  the  AzCH-CCP  Preferred  Drug  Lists  including  the  recent  updates,  visit  our  website  at The Arizona Complete Health Website:  For Providers > Pharmacy > Preferred Drug Lists.

We  encourage  all  prescribing  clinicians  to  review  our  Preferred  Drug  Lists  (PDL)  for  preferred  formulary alternatives prior to prescribing. The table below highlights some of the upcoming Formulary changes. 

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)
Cytokine and CAM Antagonists	Brand Name Humira	SIMLANDI AUTOINJECTOR NDC: 51759040202 NDC: 51759040217 HADLIMA PREFILLED SYRINGE NDC: 78206018301 NDC: 78206018601 HADLIMA PUSHTOUCH AUTOINJECTOR NDC: 78206018401 NDC: 78206018701 ADALIMUMAB-ADBM(CF) PREFILLED SYRINGE  NDC: 00597055580 NDC: 00597058589 NDC: 00597059520 ADALIMUMAB-ADBM(CF) PEN NDC: 00597054522 ADALIMUMAB-ADBM(CF) PEN PS-UV NDC: 00597054544 ADALIMUMAB-ADBM(CF) PEN CROHNS NDC: 00597054566	PA	N

*AHCCCS P&T determines whether 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)

For AzCH-CCP questions: Contact the pharmacy team (888) 788-4408 (Options 3, 7)