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Starting October 1, 2024, all Care1st members will join Arizona Complete Health-Complete Care Plan.
There is no change to your benefits or providers. New ID cards will be sent to you.
 Find more information here
Starting October 1, 2024, all Care1st members will join Arizona Complete Health-Complete Care Plan.
There is no change to your benefits or providers. New ID cards will be sent to you.
 Find more information here

Pharmacy Formulary Updates Effective January 2024

Date: 12/01/23

Effective January 1, 2024, Arizona Complete Health-Complete Care Plan (AzCH-CCP) and Care1st will implement AHCCCS formulary changes based on the recommendations from the October 25, 2023, AHCCCS Pharmacy & Therapeutics (P & T) Committee.

The Preferred Drug Lists including these recent updates are available on our websites.

We encourage all prescribing clinicians to review our Preferred Drug Lists (PDL) for preferred formulary alternatives prior to prescribing. The table below highlights some of the January Formulary changes.

Formulary Updates Effective January 1, 2024

Drug Class

Drug(s) Removed from Formulary

 

Preferred Alternative(s) on Formulary (NEW or current alternatives)

Utilization Management (PA, STEP, QL, AGE)**

*Grandfathering permitted (Y/N)

Anticonvulsants

New Class

The remaining agents in this class are Non-Preferred

*For a complete list of preferred agents in this class, please visit our website. The below list is not all inclusive.

1.     Banzel Suspension

2.     Banzel tablet

3.     Carbatrol

4.     Carbamazepine

5.     Cloabazam Suspension

6.     Clobazam tablet

7.     Diastat (Rectal)

8.     Dilantin

9.     Divlaproex Sprinkle

10.  Epidiolex

11.  Ethosuximide

12.  Felbamate

13.  Fycompa

14.  Lancosamide

15.  Lamotrigine

16.  Topiramate

17.  Valproic Acid Solution

18.  Zonisamide

QL: Nayzilam, Valtoco Nasal spray

 

PA requirements for current agents on the PDL will remain the same

Y

Antifungals- Topical

Clotrimazole Sol. (OTC)

Ketodan Foam

Ketodan Foam Kit

Votriza-AL

1.     Clotrimazole Sol. (RX) NEW

2.     Ciclopirox Sol.

3.     Ketoconazole Shampoo

4.     Nystatin Powder

5.     Tolfanate powder

6.     Terbinafine cream

N/A

N

Calcium Channel Blockers

Norliqva

1.     Katerzia

 

PA required for >7 years old

N

Hereditary Angioedema Agents  (HAE)

Orladeyo

Firazyr

1.     Haegarda (Sub-Q) NEW

2.     Icatibant (Sub-Q) NEW

3.     Cinryze (IV)

4.     Berinert (IV)

5.     Kalbitor (Sub-Q)

PA

Y

Immunologic Agents

N/A

1.     Adbry (NEW)

2.     Dupixent

PA

N

Movement Disorders

N/A

1.     Austedo XR (NEW)

2.     Austedo XR Titration Packet (NEW)

3.     Austedo

4.     Ingrezza

PA

N

Multiple Sclerosis-

New Class

The remaining agents in this class are Non-Preferred

1.     Avonex (IM)

2.     Avonex Pen (IM)

3.     Copaxone 20 mg/ml

4.     Copaxone 40 mg/ml

5.     Dalfampridine ER (Oral)

6.     Dimethyl Fumarate DR (AG) (Oral)

7.     Dimethyl Fumarate DR (Oral)

8.     Fingolimod (Oral)

9.     Kesimpta (Sub-Q)

10.  Ocrevus (IV)

11.  Rebif Rebidose Pen (Sub-Q)

12.  Rebif (Sub-Q)

13.  Teriflunomide tab (Oral)

14.  Tysabri (IV)

PA

Y

Sedative Hypnotics

N/A

 

1.     Zolpidem ER (NEW)

 

PA required for < 6 years old & PA required for > 1 hypnotic drug

N

Steroids- Topicals

N/A

1.     Fluocinolone Acetonide Sol. (Topical) NEW

2.     Oralone (Dental) NEW

3.     Triamcinolone Paste (Dental) NEW

4.     Betamethasone Dipropionate Ointment (Topical) NEW

QL

N

For AzCH-CCP questions: Contact the pharmacy team (888) 788-4408 (Options 3, 7)

For Care1st questions: Contact the pharmacy team (866) 560-4042 (Options 5, 5)