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Medicaid Formulary Updates Effective 4/1/2024

Date: 02/26/24

FORMULARY UPDATES EFFCTIVE APRIL 1, 2024

Effective April 1, 2024, Arizona Complete Health-Complete Care Plan (AzCH-CCP) and Care1st will implement AHCCCS formulary changes based on the recommendations from the January 24, 2024, AHCCCS Pharmacy & Therapeutics (P & T) Committee.

To review the AzCH-CCP Preferred Drug Lists including the recent updates, visit our website at: The Arizona Complete Health Website  > For Providers > Pharmacy > Preferred Drug Lists.

To review the Care1st Preferred Drug Lists including the recent updates, visit our website at: The Care1st Website > For Providers > Pharmacy > Preferred Drug Lists.

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 upcoming Formulary changes.

Drug ClassDrug(s) Removed from FormularyPreferred Alternative(s) on Formulary (New or Current Alternative)Utilization Management (PA, STEP,QL, AGE)***Grandfathering permitted (Y/N)
Androgenic
Agents
  • Androgel Gel packet (discontinued)
  • Androgel Gel Pump (discontinued)
  1. Testosterone Gel Pump (Androgel) (NEW)
  2. Testosterone Gel Packet (AG) (Vogelxo)
  3. Androderm Patch
PAN
Colony
Stimulating Factors 		N/A
  1. Neupogen Syringe (NEW)
  2. Neupogen Vial (NEW)
  3. Nyvepria Syringe (NEW)
  4. Udenyca autoinjector (NEW)
  5. Ziextenzo Syringe
  6. Flynetra
  7. Nivestym Syringe
  8. Nivestym Vial 
PAN
Erythropoiesis
Stimulating Proteins 		Aranesp
Syringe 
  1. Epogen
    Vial
  2. Retacrit Vial
PAY

Oncology

Oral-Hematologics 

  • Gleevec Tablet
  • Revlimid Capsule
  1. Imatinib Tablet (NEW) 
  2. Lenalidomide Capsule (NEW)
  3. Hydroxyurea Capsule
  4. Matulane Capsule
  5. Mercaptopurine Tablet
  6. Tretinoin Capsule
PAN
Ophthalmics Anti-inflammatory Immunomodulators   N/A
  1. Xiidra (NEW)
  2. Restasis 
PAN
Oral and Inhaled Pulmonary Arterial Hypertension Agents
  • Revatio Suspension
  • Adcirca Tablet
  • Sildenafil Suspension 
  1. Liqrev Suspension (NEW)
  2. Orenitram ER Tablet (NEW)
  3. Orenitram Titration Kit (NEW)
  4. Tadalafil Tablets (Adcirca) (NEW)
  5. Ambrisentan Tablet
  6. Bosentan Tablet
  7. Sildenafil Tablet 
PAN
Ulcerative
Colitis 
  • Lidalda Tablet
  • Mesalamine (AG) Tablet (Lialda)
  • Asacol HD Tablet (discontinued)
  1. Mesalamine Tablet (Generic Lialda) (NEW)
QLN

*AHCCCS P&T determines whether to permit grandfathering (continued use of a non-formulary medication). If grandfathering is not permitted, members will need to switch to the preferred formulary alternative and a new prescription may be required (see AHCCCS Policy 310-V).

 **Prior Authorization (PA), Step Therapy (STEP), Quantity Limit (QL), Age Restriction (AGE), Authorized Generic (AG)

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).

Thank you!