Notification of AHCCCS Preferred Insulin Formulary Changes
Date: 07/01/21
Effective 8/1/2021
Dear Arizona Complete Health-Complete Care Plan Providers and Staff:
Effective August 1, 2021, Arizona Complete Health (AzCH) will implement the AHCCCS formulary changes based on the recommendations from the May 19, 2021 AHCCS Pharmacy & Therapeutics (P & T) Committee. Formulary changes are located on our website.
AzCH encourages all prescribing clinicians to review the Arizona Complete Health Integrated Preferred Drug List (PDL) for preferred formulary alternatives prior to prescribing.
Below are some highlights of the Formulary changes effective August 1, 2021:
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) |
---|---|---|---|---|
Hypoglycemics Insulin and Related Agents: Rapid-Acting Insulins | Humalog Pens
Humalog Junior KwikPen
Humalog Vials
| Insulin Lispro Pen (AG)
Insulin Lispro Junior Kwikpen (AG)
Insulin Lispro Vial (AG)
|
| N |
Hypoglycemics Insulin and Related Agents: Rapid-Acting Insulins
| Novolog Cartridge
Novolog Pens
Novolog Vials | Insulin Aspart Cartridge (AG)
Insulin Aspart Pen (AG)
Insulin Aspart Vial (AG)
|
| N |
Hypoglycemics Insulin and Related Agents: Rapid-Intermediate-Acting Combination Insulins
| Humalog Mix Pens
| Insulin Aspart/Insulin Aspart Protamine Insulin Pen (AG)
Insulin Aspart/Insulin Aspart Protamine Vial (AG) NDC: 73070020011 |
| N |
Hypoglycemics Insulin and Related Agents: Rapid-Intermediate-Acting Combination Insulins
| Novolog Mix Pens
Novolog Mix Vials
| Insulin Lispro Protamine Mix FlexPen (AG)
|
| N |
Hypoglycemics Insulin and Related Agents: Intermediate-Acting Insulin
| Humulin Pen OTC | Humulin vials OTC
|
| N |
*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). AG = Authorized Generic.
Contact Pharmacy Prior Authorization at 888-788-4408 x6031278 if you have any questions.