AHCCCS Pharmacy Information

Pharmacy Updates

Sublocade & Brixadi

AHCCCS is rescinding the buy and bill requirement for Sublocade and Brixadi effective October 7, 2024. For additional inquiries, please email the pharmacy department at AHCCCSPharmacyDept@azahcccs.gov

Arizona Complete Health-Complete Care Plan (AzCH-CCP) ACC-RBHA

Arizona Complete Health - Pharmacy

When you visit this page, scroll down to where it says, “How to get your Prescriptions.” Click the plus sign to see additional information in this section. Click the Express Scripts link under the following section: Non-Title AHCCCS Enrollees assigned to AzCH-CCP can find Pharmacy Benefit details by logging into the Express Scripts website. When you register or log in, you will be able to see your pharmacy information, including your member ID card.

Mercy Care ACC-RBHA

Mercy Care ACC‑RBHA with SMI

When you visit this page, scroll down where it says, “Member portal.” Click the link that prompts you to register for the web portal. When you register or log in, you will be able to see your member ID card. You will also be able to see it on your mobile device.

The AHCCCS Pharmacy & Therapeutics Committee (Committee) is advisory to the AHCCCS Administration and is responsible for evaluating scientific evidence of the relative safety, efficacy, effectiveness and clinical appropriateness of prescription drugs. The Committee makes recommendations to the AHCCCS Administration on the development and maintenance of a statewide drug list and prior authorization criteria as appropriate. The Committee may also evaluate individual drugs and therapeutic classes of drugs.

The meetings are open to the public.

P&T Meeting Public Testimony, for persons that are not representing a pharmaceutical company, pharmacy benefit manager or related entity, may be given orally or submitted as a written document in accordance with the AHCCCS P&T Operational Policy

Each person must fill out the Public Testimony Registration Form and the Conflict of Interest Form to register for the meeting. See the AHCCCS P&T Operational Policy for deadlines.

Magellan Medicaid Administration, Inc. (MMA), part of the Magellan Rx Management division of Prime Therapeutics LLC, has been selected to manage the preferred drug list (PDL) and supplemental rebate processes. Please see the MagellanRX Management site for more information.

P&T Meeting and Class Review Schedule

Agendas & Meeting Minutes

ANNOUNCEMENT: All AHCCCS P&T meetings will be held virtually until further notice.

January 15, 2025

Current P&T Committee Member Information

P&T Application - Now Accepting New Members

The AHCCCS Pharmacy and Therapeutics Committee is now accepting new members for the following positions:

  • Health Care Providers - 1 Representative (Obstetrics and Gynecology)
  • Public - 2 Representatives (Inter-Tribal Council of Arizona and Medicaid Member)
  • AHCCCS MCO's and TRBHA - 2 Representatives (TRBHA Pharmacy Director and/or TRBHA Medical Director)
  • University Representative - 1 Representative (Researcher)

Please fill out the P&T Application and send to the Arizona Pharmacy Department ( AHCCCSPharmacyDept@azahcccs.gov ) for consideration.

Medically necessary, cost effective, federally reimbursable medications prescribed by a physician, physician’s assistant, nurse practitioner, dentist or other AHCCCS approved practitioner and dispensed by a licensed AHCCCS registered pharmacy are covered for members. Contractors are required to cover all medically necessary, clinically appropriate, cost effective medications that are federally and state reimbursable.

AHCCCS has developed a list of medications that must be available to all members when medically necessary. The Minimum Referred Prescription Drug List (MRPDL) specifies medications that are available without prior authorization as well as medication that have specific quantity limits, or require step therapy and/or prior authorization prior to dispensing to AHCCCS members. The Contractors’ medications lists shall include these medications and any additional drugs necessary to meet the needs of the Contractor’s specific patient populations. However, please note that the MRPDL is not an all-inclusive list of medications for the AHCCCS FFS and MCO Contractor Health Plans.

The list of covered medications is available for viewing at the link below:

AHCCCS MRPDL

The following are not covered under the AHCCCS Pharmacy Benefit:

  • Medication prescribed for the treatment of a sexual or erectile dysfunction, unless prescribed to treat a condition other than a sexual or erectile dysfunction and the medication has been approved by the Food and Drug Administration for the specific condition.
  • Medications that are personally dispensed by a physician, dentist or other provider except in geographically remote areas where there is no participating pharmacy or when accessible pharmacies are closed.
  • Drugs classified as Drug Efficacy Study Implementation (DESI) drugs by the Food and Drug Administration
  • Outpatient medications for members under the Federal Emergency Services Program.
  • Medical Marijuana.
  • Drugs covered under Medicare Part D for AHCCCS members eligible for Medicare whether or not the member receives Medicare Part D coverage.

AHCCCS covers the following for AHCCCS members who are eligible to receive Medicare:

  • Medically necessary barbiturates except those prescribed for the treatment of epilepsy, cancer or a chronic mental health condition, and
  • Over-the-counter medications that are not covered as part of the Medicare Part D prescription drug program and meet the requirements described in A, #4 of this Policy may be covered as part of the Contractor’s step therapy program.

Are there copayments required for prescriptions?

For a list of optional and mandatory copayments, please visit What are the Copayments?

For more information, you may contact the Pharmacy Department at AHCCCSPHARMACYDEPT@AZAHCCCS.GOV.

Archived pharmacy documents are available under ‘Pharmacy Updates’ in the AHCCCS Document Archive.