Pharmacy
Prescription drug benefits
Whether it’s pain medications after an injury or medication to manage a health condition, getting the prescription drugs you need is an important part of your health care. We want to make it as convenient for you as possible.
Learn more about your prescription drug benefits:
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About your medications
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What you need to know about your medications To help you with a medical issue, your doctor or dentist may prescribe a medication. Be sure to let your doctor know about any other medications you are taking. This includes those from another doctor and medications or herbal supplements that you buy on your own. Some drugs can cause harm if taken together. Telling your doctor what you are taking can help prevent harmful reactions. Before you leave the office, ask these questions:
- Why am I taking this medication?
- What is it supposed to do for me?
- How should the medicine be taken?
- When?
- For how many days?
- What are the possible side effects or allergic reactions of the medicine?
- What should I do if a side effect happens?
- What will happen if I don’t take this medication?
Carefully read the drug information the pharmacy gives you when you fill your prescription. It will explain what you should and should not do and possible side effects.
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e-Prescribing
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Many doctors can now electronically send prescriptions directly to pharmacies. This can help save you time and an extra trip. Ask your doctor if e‑Prescribing is an option for you.
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Formulary (Covered Medication List)
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Download the Mercy Care formulary.
You now have the ability to use the new Formulary Search Tool to find out which medications are on the formulary drug lists. You can search by drug name or drug class. The search tool will show formulary status, generic alternatives and if there are any requirements, such as prior authorization, quantity limits or age limits. The formularies can change.
Is your prescription covered?
If you need medicine, your doctor will choose one from Mercy Care’s list of covered drugs. Ask your doctor to make sure the drug is on the list.
Not sure if a certain drug is covered? Check the Preferred Drug List (PDL). This is a list of drugs that are typically covered if they are medically necessary. To search for a particular drug, click on the binocular icon in the left-hand margin and type the word you are looking for in the search box.
If you need medicine that’s not on the list and you can’t take another kind, your doctor can ask for an exception. Some medicines that don’t need a prescription are also covered when your doctor asks for them.
Prescriptions should be filled at a pharmacy that is part of the Mercy Care network. See if your pharmacy is in our network. You do not have to pay for medicines. However, in some cases, AHCCCS members are required to pay co-payments for prescriptions (for example AHCCCS Care - $2.30 for Generic and $2.30 for Brand).
Do not make any copayments because Mercy Care cannot pay you back. If you have other insurance, Mercy Care will only pay the copay if the drug is on the Mercy Care drug list.
Your prescriptions are covered by Mercy Care only if you do NOT have Medicare.
For more detailed information about your Mercy Care prescription drug coverage, please review your Member Handbook and other plan materials. If you have questions please call Member Services Monday through Friday, 7 a.m. to 6 p.m at 602-263-3000 or toll-free 1-800-624-3879 (TTY/TDD 711).
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Formulary updates
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July 2018
Additions:
- Glyxambi (Added Prior Authorization)
- Bevespi Aerosphere (Added Prior Authorization)
- Stiolto Respimat (Added Prior Authorization)
- Naratriptan added with (Quantity Level Limit) 9/30days
- Zolmitriptan added with (Quantity Level Limit) 9/30days
- Levalbuterol solution (Prior Authorization) not required for (Age Limit) < 4
- Renvela (brand only) (Added with Prior Authorization)
- Renagel (Added Prior Authorization)
- Prescription opioid cough and cold products (Age Limit) < 18 requires (Prior Authorization)
- Norvir powder
- Phytonadione tab
- Diphenhydramine liq 6.25mg
- Pediatric MVI with iron 11mg/ml
- Baclofen 5mg
- Servent Diskus (Added Prior Authorization)
Removals:
- Fosrenol
- Estazolam
- Flurazepam
- Triazolam
- Eszopiclone
- Zaleplon
- Zolpidem ER
- Zolpidem SL
- Zolpimist
- Silenor
- Meprobamate
- Mephyton
- Foradil
- Arcapta
- Albuterol solution (Step Therapy) removed
- Metaproterenol
- Striverdi
- Zafirlukast
Other Updates:
- Rizatriptan (Quantity Level Limit) changed from 12/30days to 9/30days
- Montelukast granules changed to (Prior Authorization) required for (Age Limit) > 4
- Rozerem- must use temazepam and zolpidem first
- Sildenafil specialist requirement removed
June 2018
Additions:
- Symfi (Quantity Level Limit)
- Praziquantel
- Lansoprazole ODT (Prior Authorization, Quantity Level Limit)
Removals:
- Biltricide
- Prevacid Solu Tab
May 2018
Additions:
- Colchicine capsules
- Firvanq
- Jardiance (Step Therapy Required)
- Ritonavir tablets
- Symfilo
- Synjardy, Synjardy XR (Step Therapy Required)
Removals:
- Norvir tablets
Other Updates:
- Rosuvastatin (Prior Authorization Removed, Step Therapy Added)
April 2018
Additions:
- Aprepitant combo pack
- Biktarvy
- Pulmicort Flexhaler
- Tramadol ER (Prior Authorization Required)
Removals:
- Emend combo pack
March 2018
Additions:
- Efavirenz Tab
- Methergine
Removals:
- Sustiva Tab
February 2018
Additions:
- BD Pen needles
- Efavirenz
- Estradiol 0.01% vaginal cream
- One Touch Verio High
- Tenofovir
- Vancomycin capsules (Prior Authorization Required-use First Vancomycin compounding kit)
Removals:
- Albuterol tabs (Use Syrup)
- Amcinonide topical
- Betoptic S ophthalmic
- Brimonidine 0.15% ophthalmic
- Cefaclor ER tabs
- Ciprofloxacin ER tabs
- Desoximethasone topical
- Estrace Vaginal cream
- FML Forte ophthalmic
- Gatifloxacin ophthalmic solution
- Modafinil
- Neomycin/Polymyxin HC ophthalmic
- Oxymorphone IR
- Pramasone HC cream 1-1%
- Prednicarbate topical
- Sustiva
- Terbutaline (Use Albuterol Syrup)
- Viread
Other Updates:
- Brimonidine 0.2% ophthalmic (Added Quantity Level Limit)
- Combigan ophthalmic (Added Step Therapy)
- Fentanyl lozenge (Added Prior Authorization)
- Halobetasol topical (Added Quantity Level Limit)
- Sprycel (Added Quantity Level Limit)
- Timolol ophthalmic gel (Added Step Therapy)
January 2018
Additions:
- Armodafinil (Prior Authorization Required, Quantity Level Limit)
- Carboxymethycellulose sodium ophth solun 0.25%
- Cardura XL
- Epinephrine 0.15 mg and 0.3mg Auto-Inject (Mylan)
- Opsumit (Prior Authorization Required)
- Oseltamivir suspension
- Xtampza ER(Prior Authorization Required)
Removals:
- Epclusa
- Epi Pen
- Epi Pen jr.
- Harvoni
- Hysingla ER
- Oxycontin
- Tamiflu suspension
- Technivie
- Viekira
- Viekira XR
- Zepatier
Other Updates:
- Suboxone Film (Removed Prior Authorization)
- Vivitrol (Removed Prior Authorization)
December 2017
Additions:
- Abacavir solution
- Mavyret (Prior Authorization Required per AHCCCS)
Removals:
- Ziagen Solution
Other Updates:
- Tretinoin cream/gel (Removed Step Therapy per AHCCCS)
November 2017
Additions:
- Humulin R U-500 added PA per AHCCCS
- Fosamprenavir
Removals:
- Lamotrigine IR QLL removed
- Lexiva
Other Updates:
- Lamotrigine IR (Removed Quantity Level Limit)
October 2017
Additions:
- Aptensio XR (Age Edit, Quantity Level Limit)
- Clonidine patch (Age Edit, Quantity Level Limit)
- Doxepin HCL capsules and concentrate (Quantity Level Limit)
- Doxylamine succinate 25mg
- Enoxaparin (Quantity Level Limit)
- Eszopiclone (Age Edit, Quantity Level Limit)
- Lamotrogine XR
- Meprobamate (Age Edit, Quantity Level Limit)
- Novolog 100 unit/ml Flexpen
- Novolog 100unit/ml cartridge
- Novolog 100unit/ml vial
- Novolog Mix 70/30 Flexpen
- Novolog Mix 70/30 vial
- Paroxetine solution (Quantity Level Limit)
- Paxil suspension (Quantity Level Limit)
- Pyridoxine 25mg
- Silenor (Prior Authorization required)
- Triazolam (Age Edit, Quantity Level Limit)
- Vitamin B12 SL
- Xarelto starter pack
- Zolpidem CR (Prior Authorization Required)
- Zolpidem SL (Prior Authorization Required)
- Zolpimist (Prior Authorization Required)
- Zolpimist (Prior Authorization Required)
Removals:
- Diclegis
- Lovenox
- Metadate CD
- Somnote (drug no longer marketed)
Other Updates:
- Anxiolytics (Added Age Edit)
- Bupropion tablets, XR, SR (Added Quantity Level Limit)
- Buspirone (Added Age Edit)
- Estazolam (Added Age Edit)
- Flurazepam (Added Age Edit)
- Hydroxyzine hcl tablets (Added Quantity Level Limit)
- Hydroxyzine pamoate (Added Quantity Level Limit)
- Hydroxyzine syrup (Added Quantity Level Limit)
- Mirtazapine tab, ODT (Added Age Edit)
- Nefazodone (Added Quantity Level Limit)
- Rozerem (Added Age Edit)
- Sertraline solution (Added Quantity Level Limit)
- Temazepam (Added Age Edit)
- Trazodone (Added Quantity Level Limit)
- Tybost (Prior Authorization Removed)
- Venlafaxine ER (Added Quantity Level Limit)
- Venlafaxine IR (Added Quantity Level Limit)
- Zaleplon (Added Age Edit)
- Zolpidem (Added Age Edit)
September 2017
Additions:
- Artificial tears ointment OTC
- Mesalamine 1.2GM
- Moxifloxacin 0.5% ophthalmic
- Sevelamer
Removals:
- Renvela
- Vigamox
Other Updates:
- Ceftriaxone inj. (Removed Quantity Level Limit)
August 2017
Additions:
- Adcirca (Step Therapy Required - use sildenafil)
- Albenza (Step Therapy Required - use ivermectin or pyrantel)
- Corlanor (Step Therapy Required - use beta blocker AND ACEI or ARB)
- Ergocal 2500 Unit cap
- Extavia (Prior Authorization Required)
- Isentress HD 600mg tablet
- Letairis (Quantity Level Limit)
- Lidocaine Patch (Prior Authorization Required)
- Malathion (Step Therapy Required - permethrin or pyrethrin)
- Melphalan 2mg
- Multaq (Step Therapy Required - use other antiarrhythmics first)
- Olopatadine 0.1% and 0.2% (Step Thearapy Required - use Ketotifen OTC)
- Permethrin lotion1% (Quantity Level Limit)
- Tracleer (Quantity Level Limit)
Removals:
- Alkeran 2mg
- Econazole cream
- Potassium chloride 10%, 20% solution
- Potassium chloride packet 20meq, 25meq
- Ulesfia
July 2017
Additions:
- Bydureon pen and vial (Prior Authorization Required)
- Kombiglyze XR (Prior Authorization Required)
- Lidocaine 3% (Step Thearapy Required - use Aspercreme OTC)
- Lidocaine 5% (Step Thearapy Required - use Aspercreme OTC)
- Onglyza (Prior Authorization Required)
June 2017
Additions:
- Apriso
- Desvenlafaxine ER (Prior Authorization Required, Age Limit)
- Dofetilide (Prior Authorization Required
Removals:
- Meloxicam liquid
- Pristiq brand
- Tikosyn brand
Other Updates:
- Adapalene cream, gel (Added Step Therapy - use Differin Gel OTC)
- Tretinoin cream, gel (Added Step Therapy - use Differin Gel OTC)
May 2017
Additions:
- Odefsey
Other Updates:
- Abilify Maintenna (Quantity Level Limit Added)
- Abreva (Quantity Level Limit Removed)
- Alendronate (Quantity Level Limit Removed)
- Arcapta (Quantity Level Limit Removed)
- Aristada QLL (Quantity Level Limit Added)
- Desmopressin nasal spray (Quantity Level Limit Removed)
- Estradiol patches (Quantity Level Limit Removed)
- Estring (Quantity Level Limit Removed)
- Fexofenadine (Quantity Level Limit Changed)
- Medroxyprogesterone IM (Quantity Level Limit Removed)
- Mupirocin cream (Quantity Level Limit Removed)
- Paroxetine solution (Quantity Level Limit Removed)
- Polyethylene glycol 3350 (Quantity Level Limit Removed)
- Prenatal vitamins (Quantity Level Limit Removed)
- Pseudoephedrine (Quantity Level Limit Removed)
- Rimantadine (Quantity Level Limit Removed)
- Risperidone Consta (Quantity Level Limit Added)
- Sertraline solution (Quantity Level Limit Removed)
- Spinosad suspension (Quantity Level Limit Removed)
- Tretinoin topical (Quantity Level Limit Removed)
- Vancomycin oral (Quantity Level Limit Removed)
- Ventolin HFA (Quantity Level Limit Removed)
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Refills
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The label on your medication bottle tells you how many refills your doctor has ordered for you. If your doctor has ordered refills, you may only get one refill at a time.
If your doctor has not ordered refills, you must call him/her at least five (5) days before your medication runs out. The doctor may want to see you before giving you a refill.
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Mail-order prescriptions
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Save time with mail-order prescription drugs
Do you take medications on a regular basis for an ongoing condition, like high blood pressure or arthritis? Then you may be able to join Mercy Care’s mail-order maintenance prescription drug program. This service delivers your drugs to your home or doctor’s office.
To start the mail-order process, call Mercy Care Member Services at 602-263-3000 or 1-800-624-3879 (TTY/TDD) 1-866-602-1982 (7 a.m. to 6 p.m. Monday-Friday) to request a mail-order form, or you can register online with CVS Caremark. Once registered, you will be able to order refills, renew your prescription and check the status of your order.