About the Health Choice Arizona Formulary
The Health Choice Arizona Formulary is your guide to prescription drugs covered by Health Choice Arizona. The Formulary is organized by sections. Each section includes therapeutic groups identified by either a drug class or disease state. Products are listed by generic name. Brand name products are included as a reference to assist in product recognition. Unless exceptions are noted, generally all dosage forms and strengths of the drug cited are covered. In addition, the formulary covers selected over-the-counter (OTC) products.
Here is how you can view or search the Formulary:
- View a PDF copy of the Health Choice Arizona Formulary in English.
- View a PDF copy of the Health Choice Arizona Formulary in Spanish.
- To request a printed copy of the Formulary, call Member Services toll-free at 1-800-322-8670, Monday through Friday (except holidays), 6 a.m. – 6 p.m. TTY/TDD users can call 711.
Health Choice may add or remove drugs from our Formulary during the year.
- View a PDF copy of Formulary Updates Effective 1/1/2017.
To get updated information about the drugs covered by Health Choice Arizona, call Member Services at 800-322-8670 toll-free, Monday through Friday (except holidays), 6 a.m. – 6 p.m. TTY/TDD users can call 711. You may also contact us by email at firstname.lastname@example.org
Updates Regarding Our Pharmacy Benefits Manager (PBM)
Effective July 1, 2017
In our ongoing efforts to ensure the provision of quality care and services for our members, Health Choice Arizona conducted an extensive review and evaluation of our Pharmacy Benefits Manager.
After careful consideration, Heath Choice Arizona has elected to change PBM services, effective July 1, 2017 to OptumRx. In addition to offering a robust network, our new partnership with OptumRx will enhance member access to provider and covered benefits.
If you are a pharmacy, and trying to bill for covered prescription our BIN # and PCN # is below:
If you are a pharmacist or healthcare provider and need to reach OptumRx for any questions regarding filling prescription medications that are covered through Health Choice Arizona please call OptumRx at 1-855-821-9100
We are committed to making this transition as smooth as possible. If you have any additional questions or need further information, please contact your Provider Service Representative.
Requirements or Limits on Coverage
Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:
Health Choice Arizona may require prior authorization for certain drugs. You will need to get approval from Health Choice Arizona for drugs noted with a “PA” in the drug list or for any drugs not listed in the formulary. If you do not get approval, Health Choice Arizona may not cover the cost of the drug. View a PDF copy of the Health Choice Arizona Medication Prior Authorization Criteria.
For your convenience, click here to obtain the Pharmacy Services Prior Authorization Form.
For certain drugs, Health Choice Arizona may limit the amount of the drug that our plan will cover.
You can ask Health Choice Arizona to make an exception to these restrictions or limits. Please call us at 800-322-8670.
Opioid Prescribing Guidelines
AMPM: 310-V: Prescription Medications/Pharmacy Services
AMPM: 310-V-2: 7-Day Supply Limit of Prescription Opioid Medications Exclusions Specifications
AMPM: 310-V-3: ICD-10-CM Diagnosis Code Description
Arizona Opioid Prescribing Guidelines
Chronic Non-terminal Pain (CNTP)