You are invited to participate in a survey regarding your experience using the AHCCCS
website. This survey will take approximately two minutes. Your responses will help
us ensure that you have a high quality experience.
Thank you for your interest in the AHCCCS Department of Pharmacy. This site will
keep you informed and updated on all pharmacy activities including policy updates,
guidance documents, and other pharmacy related changes in the AHCCCS program.
Continue to check the page for further updates as they become available.
August 18, 2014
The Hepatitis C Sovaldi Prior Authorization Criteria Policy is located in the AHCCCS Medical
Policy Manual (AMPM) in Section 320 - N. A link to the AMPM is provided below:
Policy Manual (AMPM)
January 4, 2013
Effective October 1, 2012 Policy 310-V Prescription Medication/Pharmacy has been
revised to include the Minimum Required Prescription Drug List (MRPDL). As described
in the policy, AHCCCS has developed a list of medications that must be available
to all members when medically necessary. The MRPDL is not an all-inclusive list
of Medications for the AHCCCS FFS and MCO Contracted Health Plans. The policy can
be found in the AMPM under
Chapter 310-V. Also, a
PDF version (Revised 5/1/2014) [PDF] of the MRPDL has been attached for utilization.
May 1, 2014
The MRPDL has been revised to include the following:
MRPDL Revised 05/01/14 [PDF]
January 1, 2013
Effective January 1, 2013 the revised formularies below apply to members enrolled
in the AHCCCS Fee for Service (non-Managed Care) population only:
December 7, 2012
This memo provides additional information and guidance on the MRPDL, the AHCCCS
Fee-For-Service Medication Lists, the MedImpact prior authorization process, the
FES dialysis pharmacy procedures, and the updated Chapter 12, Pharmacy Service for
the AHCCCS Fee-For-Service American Indian Health Plan and Federal Emergency Services
Pharmacy Policy Memo [PDF]
December 4, 2012
This Prior Authorization form applies to the AHCCCS Fee for Service (non-Managed
Care) population only and is effective 10/1/2012. This form is to be used by participating
physicians and providers to obtain coverage for any overrides of pharmacy management
procedures such as step therapy, quantity limit or other edits.
FFS Medication Request Form
Effective November 1, 2012, all handwritten prescriptions for AHCCCS enrollees must
be written on Tamper Resistant Prescription Pads (TRPP) to be in compliance with
federal regulation. AHCCCS and its Contractors were waived from this requirement
by the Centers for Medicare and Medicaid (CMS) only through October 31, 2012. Therefore,
effective November 1, 2012, AHCCCS and its Contractors are required to comply with
the TRPP requirement. For additional information, please see the memo below:
TRPP Memo dated 4/27/2012
TRPP Memo dated 11/8/2012
October 1, 2012
Effective July 1, 2012, AHCCCS is implementing new billing requirements for drugs
administered in outpatient clinical settings. These requirements are in accordance
with and support of the Federal Deficit Reduction Act of 2005, which mandates that
all providers submit the National Drug Code (NDC) on all claims with procedure codes
for physician-administered drugs in outpatient clinical settings. These services
are currently represented on submitted claims by the use of the Healthcare Common
Procedure Coding System (HCPCS) codes. There have been two minor updates to the
4/2/2012 Stakeholder memo. The revised
9/10/2012 memo replaces the 4/2/2012 Stakeholder memo. Additional questions
or needed clarification may be directed to the following email address:
July 31, 2012
Effective January 1, 2013, Medicare will begin coverage of barbiturates used for
the treatment of epilepsy, cancer or chronic mental health conditions and benzodiazepines
for any condition.
Therefore, beginning January 1, 2013 AHCCCS and its Contractors, shall not reimburse
prescription claims for barbiturates used for the treatment of epilepsy, cancer
or chronic mental health conditions or benzodiazepines prescribed for any condition
for dual eligibles.
July 12, 2012
Beginning April 11, 2012, pharmacy services provided at FQHCs and FQHC Look-Alikes
will be reimbursed under the 340B payment methodology. Since the passage of the
Affordable Care Act in March 2010, AHCCCS began participating in the Medicaid Drug
Rebate Program. Participation in this program has significantly reduced the cost
of medications through retail pharmacies as well as the cost of physician administered
medications provided to AHCCCS members. However, not all medications dispensed by
pharmacies qualify for rebates. Medications that are provided through what are known
as "340B entities" are not eligible for the drug rebates because they are purchased
at discounts known as "340B pricing."
Select the links below for additional information:
June 7, 2013
This pharmacy network listing applies to the AHCCCS Fee for Service (non-Managed Care) population only. The IHS and 638 pharmacies are included in the AHCCCS Fee for
Service MedImpact Pharmacy Network and will be listed at a later date.
2013 FFS Pharmacy Network [PDF]
Adobe Acrobat Reader is required to view PDF files. This is a free program available
from the Adobe web site. Follow the download directions on the Adobe
web site to get your copy of Adobe Acrobat Reader.