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 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!