About the BCBSAZ Health Choice Formulary
The BCBSAZ Health Choice Formulary is your guide to prescription drugs covered by BCBSAZ Health Choice. 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:Comprehensive Formulary – effective 10/1/2023
To request a printed copy of our Formularies, 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.
BCBSAZ Health Choice may add or remove drugs from our Formularies during the year. We will post Formulary updates here:Formulary Add & Deletions – effective 10/1/2023
To get updated information about the drugs covered by BCBSAZ Health Choice, 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 HCHComments@azblue.com
Requirements or Limits on Coverage
Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:
BCBSAZ Health Choice may require prior authorization for certain drugs. You will need to get approval from BCBSAZ Health Choice 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, BCBSAZ Health Choice may not cover the cost of the drug.Medication Prior Authorization Criteria
Pharmacy Services Prior Authorization Form
For certain drugs, BCBSAZ Health Choice may limit the amount of the drug that our plan will cover.
You can ask BCBSAZ Health Choice to make an exception to these restrictions or limits. Please call us at 800-322-8670.
Coverage Determination – Providers
You can request a Pharmacy Coverage Determination or exception online by visiting our Prior Authorization/Pre-Certification Portal
Note: Pharmacy prior authorization ONLY. Medical prior authorization requests (including J-code) may be submitted via the Provider Portal.
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