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AzCH-CCP Formulary update January 2023

Date: 12/02/22

Dear Arizona Complete Health-Complete Care Plan (AzCH-CCP) Providers and Staff:

Effective January 1, 2023, AzCH-CCP will implement the AHCCCS formulary changes based on the recommendations from the October 19, 2022, AHCCCS Pharmacy & Therapeutics (P & T) Committee.  To review the AzCH-CCP Preferred Drug Lists including the recent updates, visit our website at:

www.azcompletehealth.com > Providers > Pharmacy > Preferred Drug Lists

AzCH-CCP encourages all prescribing clinicians to review the AzCH-CCP 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)

Antifungals, Oral

 

 

1.       Vfend (Oral Suspension)

QL

N

Calcium Channel Blockers

 

1.       Katerzia (amlodipine Oral Suspension)

PA required for > 7 years old

N

HIV/AIDS

1.       Crixivan

2.       Viracept

3.       Invirase Tablets

4.       Stavudine Capsules

1.       Symfi (Oral Suspension)

2.       Symfi Lo (Oral Suspension)

3.       Triumeq (Tablets and Oral Suspension)

 

 

Y

*Except for Icatibant which is the generic of Firazyr.

Hereditary Angioedema Agents

 

1      Icatibant

1.       Takhzyro Vial

2.       Takhzyro Syringes
Haegarda

3.       Ruconest

1.       Cinryze (Intravenous)

2.       Berinert (Intravenous)

3.       Firazyr (Subcutaneous)

4.       Kalbitor (Subcutaneous)

5.       Orladeyo (Oral Suspension)

PA

Y

Immunomodulators

 

1.       Elidel (Topical)

2.       Protopic (Topical)

3.       Opzelura (Topical)

4.       Adbry (Subcutaneous)

 

 

1.       Tacrolimus (AG) (Topical)

2.       Pimecrolimus (AG) (Topical)

3.       Tacrolimus (Topical)

4.       Pimecrolimus (Topical)

5.       Eucrisa (Topical)

6.       Dupixent Syringe (Subcutaneous)

7.       Dupixient Pen (Subcutaneous)

PA

Y

*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)

If you have any questions, please contact the Pharmacy Prior Authorization at 1-888-788-4408 x 6031278 (TTY/TDD: 711).

                                                                                                          Thank you!