Pharmacy

Getting your medication

Mercy Care RBHA covers prescription medication when:

You get your prescriptions filled at a network pharmacy.
Your prescriptions are on our preferred drug lists. These are lists of covered drugs.
Your behavioral health medication prescriptions are written by an in-network behavioral health medical practitioner.

It's important you tell all your healthcare providers, including your dentist, about prescriptions you're already taking. Also, tell them about non-prescription medicine, vitamins or herbal supplements you take.

Preferred drug lists updates The Integrated Preferred Drug List is updated four times a year. These drug lists can change as new drugs are added and other drugs are removed. For monthly changes, you can review the Preferred Drug List Updates below. You can find the entire and most recent drug lists below.

Searching the drug lists You can now use our search tools to find out if your medication is on the preferred drug list. You can search by the drug name or drug class. These are lists of drugs that are generally covered as long as they are medically necessary.

Mercy Care RBHA approved-drug lists:
If you're a Non-Title 19/21 member determined to have a serious mental illness (SMI) or a Title 19/21 Non-SMI (CMDP, DES/DDD, or ACC Opt-Out) member, then Mercy Care RBHA only fills prescriptions for your behavioral health medications. This is your Behavioral Health Drug List | Search the Behavioral Health Drug List

If you are a Title 19/21 member determined to have a SMI, then Mercy Care RBHA fills your physical health and behavioral health medications. This is your Integrated Drug List | Search the Integrated Drug List

The Crisis Medication List is for adults or children who are Non-Title 19/21 and Non-SMI who present in crisis at any of the facility-based psychiatric urgent care centers, detox facilities and/or Access Points in Maricopa County. The medications on this list will help stabilize an individual in crisis and bridge them to a follow-up outpatient appointment.

Mercy Care RBHA may also cover your over-the-counter medications if they are on your approved-drug list. Some of these may have rules about coverage. If the rules for that medication are met, Mercy Care RBHA will cover it. Like other medications, over-the-counter drugs must have a prescription from a provider to be covered at no cost to you.

For more detailed information about the Mercy Care RBHA prescription drug coverage, please review the Member Handbook and other plan materials.

Formulary Updates

December 2018

Title 19/21 SMI Drug List Updates:

Additions:

Donepezil, donepezil ODT PA added
Memantine PA added
Mesalamine enema QLL (120ml/day)
Pentasa QLL (270 /30days)
Sildenafil citrate suspension 10 mg/mL with PA
Sulfasalazine QLL (240/30)
Tretinoin cream/gel age limitation of 26

Removals:

Benazepril & hydrochlorothiazide tab 5-6.25 mg
Interferon alfa-2b for inj 50000000 unit
Methotrexate sodium inj pf 100 mg/4ml (25 mg/ml)
Methotrexate sodium inj pf 200 mg/8ml (25 mg/ml)
Peginterferon alfa-2b for inj kit 80 mcg/0.5ml
Sodium fluoride-xylitol chew tab 1.1 (0.5 mg f)-236.79
Sodium sulfacetamide/ sulfur 10-5% emulsion
Telbivudine tab 600 mg
Tretinoin cream/gel age limitation of 35

Title 19/21 Non-SMI & Non-Title 19/21 Drug List Updates:

Additions:

None

Removals:

None

November 2018

Title 19/21 SMI Drug List Updates:

Additions:

Albendazole added with ST

Removals:

Cytra-K (all NDCs are DESI)
Albenza
Clotrimazole ointment (no longer marketed)

Title 19/21 Non-SMI & Non-Title 19/21 Drug List Updates:

Additions:

None

Removals:

None

October 2018

Title 19/21 SMI Drug List Updates:

Additions:

Arcapta Neohaler added with QLL (30 caps/ 30 days)
Aristada Initio added with QLL (2/365days)
Atomoxetine added with QLL (30/30days)
Butenafine cream
Cascara sagrada
Dutasteride
Fiber tablet, powder, capsule
Glatopa 40mg
Loratadine chew tab added with QLL (60/30days)
Magnesium Citrate soln
Magnesium Oxide tab
Methylcellulose powder, tab
Ondansetron 4mg tablet and ODT QLL changed to 90tabs/30days
Prasugrel added with QLL (30/30 days)
Procrit added with PA
Senna syrup, liquid, tab
Striverdi Respimat added with QLL (1/30days)
Tadalafil (generic Adcirca) added with STEP
Tazarotene cream added with QLL (90gm/30days)
Tymlos added with PA and QLL (1/30days)
Valganciclovir QLL added (60/30days)
Vitamin E Chew tab
Vyvanse chewable tablet added with QLL (30/30days)

Removals:

GMH/SA & Non-Title 19/21 Drug List Updates:

Additions:

Aristada Initio added with QLL (2/365 days) and age limit (PA for < 18 years)
Atomoxetine added with QLL (30/30 days) and age limit (PA for <6 years)
Bisacodyl enema, supp, tab
Cascara sagrada capsule
Fiber tablet, powder, capsule
Lithium age limit added (PA for <6 years)
Magnesium Citrate soln
Magnesium Oxide tab
Methylcellulose powder, tab
Niacin tablet, chew tab, and ER tab
Pimozide age limit added (PA for <12 years)
Senna syrup, liquid, tab
Vitamin E Chew tab
Vyvanse chewable tablet added with QLL (30/30days ) and age limt (PA for <6 years)

Removals:

Methylphenidate chewable tablet
Strattera

September 2018

Title 19/21 SMI Drug List Updates:

Additions

Eliquis starter pack added with QLL (74/30days)
Makena 275mg /1.1ml Auto Inj added with PA
Phosphorous 250mg powder for solution
Pyrethrins-piperonyl Butoxide Gel
Symtuza tablets added with QLL (30/30days)

Removals

Eurax PA removed
PHOS-NAK

GMH/SA & Non-Title 19/21 Drug List Updates:

Additions

None

Removals

None

July 2018

Title 19/21 SMI Drug List Updates

Additions:

Naratriptan tablets added with QLL (9/30 days)
Rizatriptan QLL changed (9/30days)
Zolmitriptan tablets and ODT added with QLL (9/30days)
Rozerem ST and QLL added (30/30 days)
Novolog Mix 70/30 Flexpen and Vial
Novolog 100Units/Ml Vial, Flexpen, and cartridge
Glyxambi added with PA
Norvir powder added
Phytonadione
Renagel PA added
Renvela Brand Only added with PA
Levalbuterol solution added (no PA required for age <4)
Montelukast chewable tabs added with QLL (30/30days)
Montelukast granules PA added for age > 4
Bevespi Aerosphere added with PA
Stiolto Respimat added with PA
Alprazolam ER QLL changed (30/30days)
Lorazepam 2mg tablet QLL changed (60/30)
Lorazepam Intensol QLL changed (60ml/30)
Chlordiazepoxide QLL added (60/30days)
Clorazepate 3.75mg and 7.5mg QLL added (120/30)
Clorazepate 15mg QLL added (60/30)
Oxazepam QLL added (60/30days)
Xarelto Starter Pack QLL changed to 51/30
Servent Diskus PA added

Removals:

Meprobamate
Estazolam
Flurazepam
Eszopiclone
Triazolam
Rozerem PA removed
Zaleplon
Zolpidem ER
Intermezzo SL/ Edular
Zolpimist
Silenor
Mephyton
Auryxia
Fosrenol
Sevelamer generic
Levalbuterol HFA
Montelukast granules PA removed for age > 2
Arcapta Neohaler
Foradil
Metaproterenol
Striverdi Respimat
Zafirlukast

GMH/SA & Non-Title 19/21 Drug List Updates:

Additions:

Rozerem ST and QLL added (30/30)
Haloperidol decanoate PA added for age < 18
Fluphenazine decanoate PA added for age < 18
Alprazolam ER QLL changed (30/30days)
Chlordiazepoxide QLL added (60/30days)
Clorazepate 3.75mg and 7.5mg QLL added (120/30)
Clorazepate 15mg QLL added (60/30)
Oxazepam QLL added (60/30days)
Lorazepam 2mg tablet QLL changed (60/30)
Lorazepam Intensol QLL changed (60ml/30)

Removals:

June 2018

Title 19/21 SMI Drug List Updates

Additions:

Symfi added with QLL (30/30 days)
Praziquantel
Lansoprazole ODT added with PA and QLL (30/30 days)
Tasigna 50mg added with PA and QLL (120/30 days)

Removals:

Biltricide
Sensipar smart edit PA for nephrologists
Prevacid ODT

GMH/SA & Non-Title 19/21 Drug List Updates:

Additions:

None

Removals:

None

May 2018

Title 19/21 SMI Drug List Updates

Additions:

Colchicine 0.6mg capsule
Firvanq solution
Jardiance added (Quantity Level Limit, Step Therapy Required)
Ritonavir 100mg tablet
Symfi Lo (Quantity Level Limit)
Synjardy (Quantity Level Limit, Step Therapy Required)
Synjardy XR 10/1000mg and 25/1000mg (Quantity Level Limit, Step Therapy Required)
Synjardy XR 5/1000mg and 12.5/1000mg (Quantity Level Limit, Step Therapy Required)

Removals:

Norvir tablet

Other Updates:

Rosuvastatin (Removed Prior Authorization, Added Step Therapy)

GMH/SA & Non-Title 19/21 Drug List Updates

No Monthly Updates

April 2018

Title 19/21 SMI Drug List Updates

Additions:

Biktarvy
Pulmicort Flexhaler
Tramadol ER tablets (Prior Authorization Required)

Removals:

Emend

Other Updates:

Aprepitant (Added Quantity Level Limit)

GMH/SA & Non-Title 19/21 Drug List Updates

No Monthly Updates

March 2018

Title 19/21 SMI Drug List Updates

Additions:

Efavirenz
Methergine

Removals:

Sustiva

April 2018

GMH/SA & Non-Title 19/21 Drug List Updates

No Monthly Updates

February 2018

Title 19/21 SMI Drug List Updates

Additions:

Atazanavir tablets
BD Pen Needles
Efavirenz
Estradiol 0.01% vaginal cream
Juluca (Quantity Level Limit)
Tenofovir
Vancomycin capsules (Prior Authorization Required -use First Vancomycin Solution)

Removals:

Other Updates:

Brimonidine 0.2% ophthalmic (Added Quantity Level Limit)
Ciprofloxacin 250mg/5ml (Added Quantity Level Limit)
Clobetasol Cream Emollient 0.05% (Added Quantity Level Limit)
Combigan (Added Step Therapy)
Fentanyl lozenges (Added Prior Authorization)
Halobetasol topical (Added Quantity Level Limit)
Sprycel (Added Quantity Level Limit)
Timolol gel (Added Step Therapy)

GMH/SA & Non-Title 19/21 Drug List Updates

No Monthly Updates

January 2018

Title 19/21 SMI Drug List Updates

Additions:

Armodafinil (Prior Authorization Required, Quantity Level Limit)
Carboxymethycellulose sodium ophth soln 0.25%
Epinephrine 0.3mg/0.3ml and 0.15mg/0.15ml Pens (Mylan)
Opsumit (Prior Authorization Required)
Xtampza ER (Prior Authorization Required)

Removals:

Other Updates:

GMH/SA & Non-Title 19/21 Drug List Updates

No Monthly Updates

How to get your prescriptions

If you need medicine, your provider chooses a medication from our list of preferred drugs. Your provider writes you a prescription. Ask your provider to make sure that the medicine is on the list.

Take the prescription to a network pharmacy to have it filled.
Show your Mercy Care member ID card at the pharmacy.
If you only get behavioral health services from Mercy Care RBHA, you will not have an ID card. Your ID number is the same as your AHCCCS ID number. Ask your pharmacist to bill Mercy Care RBHA.

How to find a network pharmacy

You can find a network pharmacy by:

Searching for a pharmacy in your area.
Calling Mercy Care RBHA Member Services at 602-586-1841 or 1‑800‑564-5465; (TTY/TDD) 711. Ask the representative to help you find a network pharmacy in your area.

All prescriptions must be filled at a network pharmacy. Mercy Care RBHA does not cover prescriptions filled at other pharmacies.

Mail-order prescription

If you take medicine for an ongoing health condition, you may be able to have those medicines mailed to your home. These may be medications for conditions such as high blood pressure or arthritis.

To start the mail-order process, complete a mail-order request form.

Mail

Call Mercy Care RBHA Member Services at 1-800-564-5465; (TTY/TDD 711) to request a mail-order form. Or, you can download a mail-order service form here:

Mail-order service form - English | Mail-order service form - Spanish

Online

Register online with CVS Caremark at www.caremark.com. Once you're registered, you can order refills, renew your prescription and check on your order.

Medicine not on the approved-drug lists

If your medicine is not on an approved-drug list, you can:

Ask your provider for a similar drug that is on the list.
Ask your provider to ask Mercy Care RBHA to cover your drug. Your provider will go through the prior authorization process. Your provider will know how to do this.

Prescription refills

Your medicine bottle label says how many refills you can have. If you think you may need a refill, you must contact your provider at least five days before you run out of medicine. When you call, ask your provider about getting a refill. Your provider may want you to make an appointment before giving you a refill.

Questions to ask about your medicine

Mercy Care wants you to be as healthy as possible. This includes knowing about the different medicines you need to take.

To help, we have included a list of questions you should always ask your provider when about a prescription.

Why am I taking this medicine? What is it supposed to do for me?
How should the medicine be taken? When? For how many days?
Are there any side effects or possible allergic reactions to this medicine?
What should I do if I have a side effect or allergic reaction?
What will happen if I don’t take this medicine?

Carefully read the drug information the pharmacy gives you with your medicine. It will tell you what you should and should not do while taking the medicine. If you have questions after you get your medicine, ask to talk with the pharmacist or call your provider.

Also, check out Seeing a Doctor <<LINK to flyers>> for more tips to prepare you for a doctor’s visit.