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Pharmacy

Arizona Complete Health is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Arizona Complete Health members.

Arizona Complete Health covers prescription medications and certain over-the-counter medications with a written order from an Arizona Complete Health provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.

Medicaid Preferred Drug Lists

Arizona Complete Health-Complete Care Plan Comprehensive Preferred Drug List

The Arizona Complete Health-Complete Care Plan Comprehensive Drug List (PDL) includes drugs that have been reviewed and approved by a committee of doctors and pharmacists. This is not a complete listing of all covered drugs. If you need a drug that is not on the drug list, please call Arizona Complete Health-Complete Care Plan Provider Customer Service at 1-866-796-0542 and ask if it is covered.

Visit AHCCCS to view or download:

 

    Special Note on Buprenorphine tablets:

    PA REQUIRED unless the member is pregnant or nursing.

    If the member is pregnant or nursing:
    The prescriber must note the following ICD-10 codes on the prescription:

    • 1. O09.91 - Supervision of high risk pregnancy, 1st Trimester.
    • 2. O09.92 - Supervision of high risk pregnancy, 2nd Trimester.
    • 3. O09.93 - Supervision of high risk pregnancy, 3rd Trimester.
    • 4. O09.91 - Supervision of high risk pregnancy- use for Postpartum Nursing Mothers.

    The first digit of the diagnosis code is the Letter - O and the second digit is the number, Zero - 0

    The pharmacy should use these codes when submitting the prescription to override PA requirements for this drug. 

    Arizona Complete Health-Complete Care Plan Behavioral Health Drug List

    The Arizona Complete Health-Complete Care Plan Behavioral Health Drug List (BHDL) includes the behavioral health drugs that are listed on the AHCCCS Drug List. The BHDL applies to the following members:

    • Non-Title 19 and Non-Title 21 persons with the SMI, serious mental illness, designation.
    • Non-Title 19 and Non-Title 21 children and adolescents with the SED, serious emotional disturbance, designation.
    • Title 19 or Title 21 members who are only enrolled in the Arizona Complete Health-Complete Care Plan Behavioral Health Plan.

    The BHDL is not a complete list of all drugs used to treat behavioral health conditions. If you need a drug that is not on the BHDL, you may need to fax a prior authorization request to 833-546-1508 or send it electronically through CoverMyMeds. See our Prior Authorization Check Tool for more information.

    You also may call the Arizona Complete Health-Complete Care Plan Provider Customer Service at 1-866-796-0542 if you have any questions about the medications not listed on the BHDL.

    PDF to View or Download:

      Special Note on Buprenorphine tablets:

      PA REQUIRED unless the member is pregnant or nursing.

      If the member is pregnant or nursing:
      The prescriber must note the following ICD-10 codes on the prescription:

      • 1. O09.91 - Supervision of high risk pregnancy, 1st Trimester.
      • 2. O09.92 - Supervision of high risk pregnancy, 2nd Trimester.
      • 3. O09.93 - Supervision of high risk pregnancy, 3rd Trimester.
      • 4. O09.91 - Supervision of high risk pregnancy- use for Postpartum Nursing Mothers.

      The first digit of the diagnosis code is the Letter - O and the second digit is the number, Zero - 0

      The pharmacy should use these codes when submitting the prescription to override PA requirements for this drug. 

      Pharmacy Prior Authorization Criteria

      View AHCCCS Pharmacy Information


      *Arizona Complete Health-Complete Care Plan utilizes Prior Authorization criteria that has been reviewed and approved by AHCCCS.

      **Additional PA criteria may apply. For drug specific PA criteria not included on the AHCCCS Fee-For-Service PDF (link above), please call provider services at 1-888-788-4408 to request a copy of the PA criteria.

      Electronic Prescription Prior Authorization Submissions


      Submit your prior authorization (PA) requests electronically through our preferred solution CoverMyMeds. Electronic prior authorization (ePA) automates the PA process making it a quick and simple way to complete PA requests. The ePA process is HIPAA compliant and enables faster determinations. You may also use this link to track ePA requests.

      Pharmacy Prior Authorization Fax Form (PDF)

      Medical (Biopharmacy) Prior Authorization Fax Form (PDF)

      Oncology Prior Authorization Requests (Outpatient)

      The requesting physician must complete an authorization request using one of the following methods:

      Please note:
      Inpatient requests for chemotherapy should continue to be submitted via the       Arizona Complete Health’s Secure Provider Portal.

      Site of Care

      Specialty infusion therapy is the intravenous or injectable administration of medication that helps members manage complex and often chronic conditions. Site of Care is defined as the redirection of administration and/or dispensing of specialty drugs in outpatient facilities. 

      Site of Care Resources

      Other Resources

       

      Marketplace and Medicare Preferred Drug Lists

      Ambetter from Arizona Complete Health pharmacy information is available using the following link:
      Ambetter from Arizona Complete Health Pharmacy

      Wellcare by Allwell Health Formularies

      Covering Year 2024