Formulary Update effective 10.01.2023

Date: 08/31/23

Dear Providers and Staff:

Effective October 1, 2023, Arizona Complete Health-Complete Care Plan (AzCH-CCP) and Care1st will implement AHCCCS formulary changes based on the recommendations from the May 23, 2023, AHCCCS Pharmacy & Therapeutics (P & T) Committee.

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

To review the Care1st Preferred Drug Lists including the recent updates, visit our Care 1st 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 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)
Anticoagulants	Pradaxa Pellet Pack	Eliquis tablet Eliquis Dose Pack Pradaxa tablet Xarelto tablet Xarelto Dose Pack Warfarin	QL	N
Antimigraine Agents, CGRP	Aimovig Migergot Rectal	Ajovy Cafergot Emgality Syringe 120 mg Emgality Pen Ubrelvy	PA	Aimovig- Y Migergot Rectal- N
COPD Agents Antimuscarinics- Long-Acting	N/A	Spiriva Respimat (NEW) Spiriva HandiHaler Turdoza Pressair	N/A	N
Cytokine and CAM Antagonists	Avsola	Enbrel Kit, Enbrel Syringe Enbrel Pen, Enbrel Vial Enbrel Mini Cartridge Humira Kit, Humira Pen Kit Infliximab (NEW) Orencia Clickject, Orencia Syringe Otezla Xeljanz (immediate release) tablet	PA	N
Glucagon Agents	Glucagon Emergency Kit (by Eli Lilly)	Glucagon injection Glucagon Emergency Kit (by Amphastar) Gvoke Pen Gvoke Syringe (NEW) Gvoke Vial (NEW) Zegalogue Autoinjector (NEW)	QL	Y
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)
Progestational Agents	Makena 250 mg/ml Makena Auto Injector	Medroxyprogesterone acetate Medroxyprogesterone acetate (AG) Norethindrone acetate Progesterone capsule	N/A	N Products have been withdrawn from the market
Stimulants and Related Agents	Focalin XR (Brand)	Dexmethylphenidate ER (NEW) Adderall XR Amphetamine Salt Combination Atomoxetine, Atomoxetine (AG) Concerta Daytrana Patch Dexmethylphenidate Dexmethylphenidate (AG) Dextroamphetamine tablet Methylin Solution Methylphenidate Methylphenidate CD Methylphenidate CD (AG) Ritalin LA 10 mg capsule Vyvanse capsule Clonidine ER Guanfacine ER	PA required for ages < 6 years old/ QL	N

*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!