Pharmacy

HOW TO GET YOUR PRESCRIPTIONS 

If you need medicine, your provider chooses a medication from our list(s) of preferred drugs.

• Your provider writes a prescription for you. Ask your provider to make sure that the medicine is on one of the lists.
• Take the prescription to a network pharmacy to have it filled.
• Show your Care1st Health Plan Arizona member ID card to the pharmacy staff.
• If you paid for medications that qualify for a reimbursement, please complete the Care1st Medicaid Prescription Claim Reimbursement Form and fax as directed.

How to find a network pharmacy

• Searching our directory for using the Find a Provider tool
• Calling Member Services at 1-866-560-4042 (TTY/TDD: 771). Ask the representative to help you find a network pharmacy in your area.

All prescriptions must be filled at a network pharmacy. Care1st Health Plan Arizona does not cover prescriptions filled at other pharmacies.

Prescription refills

Your medicine bottle’s label says how many refills you can have. If you think you may need a refill, you must contact your provider at least five days before you run out of medicine. When you call, ask your provider about getting a refill. Your provider may want you to make an appointment before giving you a refill.

Medication home delivery

If you need medication home delivery services you can contact Member Services at 1-866-560-4042 (TTY/TDD: 771).

The Preferred Drug List (PDL) is the list of drugs covered by Care1st. Care1st works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered.

Care1st Health Plan Arizona covers prescription medication when:

• Your medication is on one of our preferred drug lists
• You get your prescriptions filled at a network pharmacy
• Your prescriptions are written by an in-network medical practitioner

You may be responsible for medication copayments.

It is important that you tell all your healthcare providers, including your dentist, about prescriptions you are already taking. Also, tell them about non-prescription medications, vitamins or herbal supplements you take.

Finding your medication(s) on the Drug Lists

• You can search by the drug name.
• The lists include drugs that are generally covered.

Care1st Health Plan Arizona has three approved drug lists (formularies); Integrated, Behavioral and Crisis. You can view the drug lists using the following links:

Integrated Health

PDF

• Care1st Health Plan Arizona Integrated Preferred Drug List - English (PDF)
• Care1st Health Plan Arizona Integrated Preferred Drug List - Spanish (PDF)

Searchable Integrated Preferred Drug List

• Arizona Medicaid Integrated Formulary Search Tool

Machine Readable Format (JSON)

• Care1st Health Plan Arizona Integrated Preferred Drug List (JSON)

In accordance with the CMS Transparency in Coverage Final Rule (84 FR 65524),  Care1st Health Plan Arizona has made public the preferred drug list in a machine-readable file format (MRF).

Behavioral Health

PDF

• Care1st Health Plan Arizona Behavioral Health Preferred Drug List - English (PDF)
• Care1st Health Plan Arizona Behavioral Health Preferred Drug List - Spanish (PDF)

Searchable Behavioral Health Preferred Drug List 

• Arizona Medicaid Behavioral Health Search Tool

Machine Readable Format (JSON)

• Care1st Health Plan Arizona Behavioral Health Preferred Drug List (JSON)

In accordance with the CMS Transparency in Coverage Final Rule (84 FR 65524),  Care1st Health Plan Arizona has made public the preferred drug list in a machine-readable file format (MRF).

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)
• Title 19/21 members with a behavioral health only benefit through Care1st Health Plan Arizona

Crisis

• Care1st Health Plan Arizona Crisis Preferred Drug List - English (PDF)
• Care1st Health Plan Arizona Crisis Preferred Drug List - Spanish (PDF)

Substance Abuse Block Grant (SABG)

• Care1st Health Plan Arizona Substance Abuse Block Grant (SABG) Medication List - English (PDF)
• Care1st Health Plan Arizona Substance Abuse Block Grant (SABG) Medication List - Spanish (PDF)

Over the Counter (OTC)

• Care1st Health Plan Arizona OTC Drug List for Dual Eligible - English (PDF)
• Care1st Health Plan Arizona OTC Drug List for Dual Eligible - Spanish (PDF)

OTC drugs are non-prescription drugs that are only covered through the prescription drug benefit if prescribed by a medical practitioner.

Medications not on the approved drug lists

If your medicine is not on our approved-drug list(s), you can:

• Ask your provider for a similar drug that is on the list.
• Ask your provider to ask Care1st Health Plan Arizona to cover your drug. Your provider will go through a prior authorization process. Your provider will know how to do this.

Care1st wants you to be as healthy as possible. This includes knowing about the different medicines you need to take. To help, we have included a list of questions you should always ask your provider about a prescription.

• Why am I taking this medicine? What is it supposed to do for me?
• How should the medicine be taken and for how long?
• Are there any side effects or possible allergic reactions to this medicine?
• What should I do if I have a side effect or allergic reaction?
• What will happen if I don’t take this medicine?

Carefully read the drug information the pharmacy gives you with your medicine. It will tell you what you should and should not do while taking the medicine. If you have questions after you get your medicine, ask to speak with the pharmacist or call your provider.