Last Updated on April 15, 2022
Your doctor may prescribe medication as part of your health care. It is important that you follow your doctor’s instructions and take the medication as your doctor has prescribed it.
You must have your prescription filled by a Health Choice Arizona participating pharmacy. Visit our Pharmacy Directory to search for a participating pharmacy in your area.
Health Choice Arizona provides a closed drug Formulary (medicine) benefit for its members. This means that if the drug is not in the Health Choice Formulary, Health Choice Arizona must first approve the prescription drug before you can purchase it at the pharmacy.
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:
To request a printed copy of our Formularies, call Member Services toll-free at 1-800-322-8670 (TTY 711), 8 a.m. – 5 p.m., Monday-Friday (except holidays).
Health Choice Arizona may add or remove drugs from our Formularies during the year. We will post Formulary updates here:
Additional information about medications can be accessed by logging into the CVS Caremark website.
- Learn about drug interactions
- Learn about drug side effects
- Learn whether generic substitutes are available for specific brand name drugs
- Find a pharmacy in the Health Choice network
- Register to use the CVS Mail Service Pharmacy or order a refill by mail
To get updated information about the drugs covered by Health Choice, call Member Services toll-free at 1-800-322-8670 (TTY 711), 8 a.m. – 5 p.m., Monday-Friday (except holidays). You may also contact us by e-mail at HCHComments@azblue.com
As a value added service to our members, Health Choice Arizona offers members the option of ordering their prescriptions by mail. If you take prescription medications on a regular basis for allergies, high blood pressure, diabetes, arthritis or other ongoing conditions, consider home delivery. It’s a service available at no additional cost to you.
When you order prescription drugs through CVS Caremark, you must order at least a 30-day supply, and no more than a 100-day supply of the drug.
Generally, it takes 14 days to process your order and ship it to you. However, sometimes your mail order may be delayed. If for some reason your order cannot be delivered within 14 days, a pharmacy representative may contact you.
Benefits of Home Delivery
- You can skip the trip to a participating pharmacy – your prescriptions are delivered directly to your home.
- You don’t have to pay for home delivery – standard shipping of your prescriptions is free.
- You only need to order refills once every three months – you get up to a 100-day supply of your medication with each order. (**except opioids)
- You can speak to a pharmacist anytime, day or night – the Pharmacy never closes.
- You can order refills from home – by phone, fax, mail or Internet. To order a refill by mail, click here.
- You can access the Caremark member web portal at https://www.caremark.com/
For more information about getting your prescriptions delivered to your home from the Pharmacy, please call Member Services at 1-800-322-8670 (TTY 711), 8 a.m. – 5 p.m., Monday-Friday (except holidays). Or, you may e-mail Member Services at HCHComments@azblue.com.
Health Choice Arizona covers both brand name and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug, but generic drugs usually cost less than brand name drugs. Generic drugs are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:
Prior Authorization: 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.
Quantity Limits: For certain drugs, Health Choice Arizona may limit the amount of the drug that our plan will cover. For example, Health Choice Arizona provides 30 units per 30 days of Zolpidem.
You can ask Health Choice Arizona to make an exception to these restrictions or limits. For more information about prescription drug restrictions or limits, call Member Services toll-free at 1-800-322-8670 (TTY 711), 8 a.m. – 5 p.m., Monday-Friday (except holidays).
What if the drug I need is not on the Prescription Drug List or the drug has a restriction such as a Quantity Limit, Step Therapy or Prior Authorization requirement?
Your provider can:
- Prescribe a similar drug that is on the prescription drug list or
- Ask Health Choice Arizona to make an exception and cover the medically necessary drug through the prior authorization process. Your provider can submit an exception request to Health Choice Arizona online, by phone or by fax.
- Submit the request online at https://healthchoice.promptPA.com or
- Call Health Choice Member Services at 480-968-6866 or 1-800-322-8670 (outside Maricopa County) or
- Send the request by fax at (877)422-8130
Most Health Choice Arizona members receive prescriptions at no charge, $0. A mandatory copay of $2.30 is charged to persons in families with children that are no longer eligible due to earnings – also known as Transitional Medical Assistance (TMA).
Comprehensive Formulary – effective 04/01/2022
Behavioral Health Comprehensive Formulary – effective 04/01/2022
Crisis Medication List – effective 04/01/2022
Medication Prior Authorization Criteria –Effective 4/01/2022
Prior Authorization Grid – effective 04/1/2022
AHCCCS Acute and Long Term Care Drug List
AHCCCS Behavioral Health Drug List
SABG Medication List
For information and assistance with prescription drugs, or to request a copy of the Health Choice Arizona Formularies, call Member Services toll-free at 1-800-322-8670.
You may also contact us by e-mail at HCHComments@azblue.com.
Hours of Operation
8 a.m. – 5 p.m., Monday-Friday (except holidays).