Pharmacy
Care1st Health Plan Arizona is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Care1st members.
Care1st Health Plan Arizona covers prescription medications and certain over-the-counter medications with a written order from a Care1st provider. The pharmacy program does not cover all medications. Some medications may require prior authorization, and some may have limitations. Please review your patient’s plan preferred drug list for additional details. For Care1st Pharmacy escalations please email our Pharmacy team.
Preferred Drug Lists
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:
- 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
Machine Readable Format (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).
- 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
Machine Readable Format (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
Prior Authorization
To prescribe a drug that requires prior authorization and/or a drug that is not on the Care1st preferred drug lists, providers can submit a request using CoverMyMeds or by completing and faxing the Pharmacy Prior Authorization Request Form to 602-778-8387.
Electronic Prior authorizations (ePA) are a quick and simple way to complete PA requests. The ePA process is HIPAA compliant and allows for faster determinations. You can also easily track your ePA requests.
Submit your Prior authorization (PA) requests electronically through our preferred solution CoverMyMeds:
**If prior authorization is not obtained in advance, the member will not be able to fill the prescription at the pharmacy, causing a delay in obtaining needed medication.
Additional Resources
Please view the links below for information regarding the RSV/Synagis Season:
Electronic Prescribing (E-Prescribing) occurs when a prescriber uses a computer or handheld device with software that enables the prescriber to electronically route the prescription to the patient's choice of pharmacy.
Additional advantages of e-prescribing include:
- Electronic access to patient’s prescription benefit
- Electronic access to patient’s medication history
E-Prescribing is a recognized and proven tool to improve member’s health outcomes. For additional information on e-prescribing click here to see the E-Prescribing Flyer (PDF).
- Arizona Controlled Substance Prescription Monitoring Program Website
- FDA Drug Shortages Resource Center
- Biosimilar Tool Kit
- Opioid Training Tool Kit
- AHCCCS - AZ Opioid Epidemic Act
- CDC Clinical Tools for Primary Care Providers
- AZ Opioid Prescribing Guidelines (PDF)
- CDC Guideline for Prescribing Opioids for Chronic Pain (PDF)
- CDC Checklist for Prescribing Opioids for Chronic Pain (PDF)
- HHS Pain Management Best Practices
- Calculating Total Daily Dose of Opioids for Safer Dosage (PDF)
- AACC Academy- Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients (PDF)
- Substance Use Screening Tools
Prior Auth Criteria
Care1st utilizes PA criteria that has been reviewed and approved by AHCCCS. To review requirements for a drug that requires PA or is not on the Care1st formulary visit the AHCCCS Pharmacy page.
Additional PA criteria may also apply. For drug specific PA criteria not included on the AHCCCS Fee-For-Service PDF (link above), please review additional criteria below or call provider services at 1-866-560-4042 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 |
| Histrelin Acetate (Vantas, Supprelin LA) (PDF) | AZ.CP.PHAR.172 |
| 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 |
Pharmacy Search
To find a network pharmacy, search our directory by using the Find a Provider tool.
All prescriptions must be filled at a network pharmacy. Care1st Health Plan Arizona does not cover prescriptions filled at other pharmacies.