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
PDF to View or Download
Searchable Integrated Preferred Drug List
Machine-Readable File (JSON)
- Arizona Complete Health Integrated Preferred Drug List Machine Readable File (JSON)
In accordance with the CMS Transparency in Coverage Final Rule (84 FR 65524), Arizona Complete Health has made public the preferred drug list in a machine-readable file format (MRF).
- Please note: Behavioral Health Drug List (BHDL) is ONLY for the following members:
- Non-Title 19/21 persons determined to have a serious mental illness (SMI)
- Non-Title 19/21 children/adolescents determined to have a serious emotional disturbance (SED)
PDF to View or Download
Searchable Behavioral Health Preferred Drug List
Machine-Readable File (JSON)
- Arizona Complete Health Behavioral Health Preferred Drug List Machine Readable File (JSON)
In accordance with the CMS Transparency in Coverage Final Rule (84 FR 65524), Arizona Complete Health has made public the preferred drug list in a machine-readable file format (MRF).
PDF to View or Download
PDF to View or Download
PDF to View or Download
Pharmacy Prior Authorization Criteria
*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.
See below for additional criteria not found on AHCCCS Fee-For-Service list
| POLICY TITLE | POLICY NUMBER |
|---|---|
| Alpha1-Proteinase Inhibitors (Glassia, Prolastin-C, Zemaira) (PDF) | AZ.CP.PHAR.94 |
| Concomitant Antidepressant (PDF) | AZ.CP.PMN.11 |
| Concomitant Antipsychotic (PDF) | AZ.CP.PMN.10 |
| EPSDT Benefit for Pediatric Members (PDF) | AZ.CP.PMN.234 |
| Hepatitis B Drugs- Entecavir (Baraclude) and Adefovir (Hepsera) (PDF) | AZ.CP.PMN.03 |
| Herceptin Biosimilars Trastuzumab-Hyaluronidase (PDF) | AZ.CP.PHAR.228 |
| Infusion Site of Care Optimization (PDF) | AZ.CP.PHAR.493 |
| Multiple Sclerosis Drugs (Lemtrada, mitoxantrone, Tysabri, Ocrevus, Ponvory) (PDF) | AZ.CP.PHAR.1020 |
| Proton Pump Inhibitors (PDF) | AZ.CP.PMN.1002 |
| Rifapentine (Priftin) (PDF) | AZ.CP.PMN.05 |
| Rituximab (Rituxan, Riabni, Ruxience, Truxima, Rituxan, Hycela) (PDF) | AZ.CP.PHAR.260 |
| SABG Non PDL drug (PDF) | AZ.CP.PMN.1009 |
| Skin Substitutes (PDF) | AZ.CP.PHAR.185 |
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:
- Log into New Century Health’s Provider Web Portal
- Submit an eFax to New Century Health at 1-213-596-3783 or send email to New Century Health's eFax email address.
- Contact New Century Health’s Utilization Management Intake Department at 1-888-999-7713, Option 2 (Monday through Friday, 5 a.m. – 5 p.m. PST)
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.
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