Pharmacy Updates and Information


Welcome to the new AHCCCS Pharmacy Information Website!

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.


Hepatitis C Sovaldi Prior Authorization Criteria Policy

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:

AHCCCS Medical Policy Manual (AMPM)


Policy 310-V Prescription Medication/Pharmacy Revised to Include the MRPDL

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) (RTF version (Revised 5/1/2014) ) of the MRPDL has been attached for utilization.

May 1, 2014
The MRPDL has been revised to include the following:

  • Ultresa (pancrelipase) was added with a quantity limit of 500
  • Tudorza Pressair (aclidinium bromide) was added to the MRPDL
  • Amitiza (lubiprostone) – was added to the MRPDL
  • Linzess (linaclotide) – was added to the MRPDL

MRPDL Revised 05/01/14 [PDF] | [RTF]


Formularies for AHCCCS Fee-For-Service (Non-Managed Care) Members Only

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:


AHCCCS Fee-For-Service Pharmacy Policy Memo

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 Dialysis recipients.

AHCCCS Fee-For-Service Pharmacy Policy Memo [PDF] | [RTF]


Fee for Service Medication Request Form - REVISED

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 [PDF]


Tamper Resistant Prescription Pads

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 [PDF] | [RTF]

TRPP Memo dated 11/8/2012 [PDF] | [RTF]


Billing Requirements for Drugs Administered in Outpatient Clinical Settings

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 [PDF] (revised 9/10/2012 memo [RTF]) replaces the 4/2/2012 Stakeholder memo. Additional questions or needed clarification may be directed to the following email address:


AHCCCS’ Dual Eligible Pharmacy Benefit Changes

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.


340B Pricing Update 

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:


Fee for Service Network

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] | [RTF]


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