Pharmacy

Getting your medication

Mercy Care RBHA covers prescription medication when:

  • You get your prescriptions filled at a network pharmacy. (Find 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.

August 2019

Title 19/21 SMI Drug List Updates:

Additions:

  • Adcirca – Brand only (Prior Authorization Required)
  • Alendronate Sodium Soln
  • Bicillin L-A 1200000 Unit/2ml
  • Bicillin L-A 2400000 Unit/4ml
  • Bicillin L-A 600000 Unit/ml
  • Bivigam (Prior Authorization Required)
  • Carimune NF Nanofiltered (Prior Authorization Required)
  • Cerdelga (Prior Authorization Required)
  • Elelyso (Prior Authorization Required)
  • Farxiga (Prior Authorization Required)
  • Flebogamma Dif (Prior Authorization Required)
  • Fulphila (Prior Authorization Required)
  • Gamastan S-D (Prior Authorization Required)
  • Gammagard S-D (Prior Authorization Required)
  • Gleevec – Brand only (Prior Authorization Required)
  • Hizentra (Prior Authorization Required)
  • Imbruvica Tablets (Prior Authorization Required)
  • Invokana (Prior Authorization Required)
  • Letairis – Brand only (Prior Authorization Required)
  • Leukeran (Prior Authorization Required)
  • Lidocaine Patch 4% (Quantity Level Limit)
  • Lorcaserin HCl Tab ER 24hr 20mg (Prior Authorization Required, Quantity Level Limit)
  • Miglustat (Prior Authorization Required)
  • Nplate (Prior Authorization Required)
  • ProAir – Brand only
  • Retacrit (Prior Authorization Required)
  • Revatio solution – Brand only (Prior Authorization Required for age > 12)
  • Tracleer – Brand only (Prior Authorization Required)
  • Udenyca (Prior Authorization Required)
  • Vpriv (Prior Authorization Required)

Removals:

  • Arcapta Neohaler
  • Bupropion HCl Tab ER 24hr 450mg
  • Butalbital-Acetaminophen-Caffeine Cap 50-300-40mg
  • Butalbital-Acetaminophen-Caffeine Cap 50-325-40mg
  • Desvenlafaxine Succinate ER
  • Emsam
  • Epinastine HCl Ophth Soln 0.05%
  • Epogen
  • Erythromycin Ethylsuccinate For Susp
  • Escitalopram Oxalate Soln
  • Prefest
  • Etidronate Disodium
  • Etodolac Tab ER 24hr
  • Fluoxetine DR
  • Fluvoxamine Maleate ER
  • Glipizide-Metformin
  • Iclusig
  • Imatinib
  • Isocaboxazid
  • Jakafi
  • Marplan
  • Melphalan
  • Nefazodone HCl
  • Neulasta
  • Ofloxacin Otic
  • Olopatadine HCl Ophth Soln 0.2%
  • Opsumit
  • Paroxetine ER
  • Paxil Sus 10mg/5ml
  • Pexeva
  • Phenelzine Sulfate
  • Procrit
  • Purixan Solution
  • Riomet
  • Segluromet
  • Steglatro
  • Striverdi Respimat
  • Tasigna
  • Thalomid
  • Tranylcypromine Sulfate
  • Tymlos
  • Tyvaso
  • Ventavis
  • Ventolin HFA
  • Viibryd
  • Zolinza

Other Updates:

  • Azelastine Ophth Soln 0.2% (Added Quantity Level Limit)
  • Baraclude Oral Soln 0.05 mg/ml (Prior Authorization Required)
  • Butalbital-Acetaminophen-Caffeine Tab 50-325-40mg (Added Quantity Level Limit)
  • Calcipotriene Soln 0.005%, Calcipotriene cream 0.005%, Calcipotriene Oint 0.005% (Prior Authorization Required)
  • Citalopram Hydrobromide Oral Soln 10mg/5ml (Added Age Limit)
  • Evotaz Tablet 300-150mg (Added Quantity Level Limit)
  • Fluoxetine HCl Solution 20mg/5ml (Added Age Limit)
  • Sertraline HCl Oral Concentrate For Solution 20mg/ml (Added Age Limit)

 

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

Additions:

  • None

Removals:

  • Desvenlafaxine Succinate ER
  • Emsam
  • Escitalopram Oxalate Soln 5 Mg/5ml
  • Fluoxetine DR
  • Fluvoxamine Maleate ER
  • Marplan
  • Nefazodone HCl
  • Paroxetine ER
  • Paxil Sus 10mg/5ml
  • Pexeva
  • Phenelzine Sulfate
  • Tranylcypromine Sulfate
  • Viibryd

Other Updates:

  • Citalopram Hydrobromide Oral Soln 10mg/5ml (Added Age Limit)
  • Fluoxetine HCl Solution 20mg/5ml (Added Age Limit)
  • Sertraline HCl Oral Concentrate for Solution 20mg/ml (Added Age Limit)

 

July 2019

Title 19/21 SMI Drug List Updates:

Additions:

  • Avastin Inj
  • Cefixime Cap 400mg (Quantity Level Limit)
  • Erlotinib Tab 150mg (Prior Authorization Required)
  • Herceptin Inj
  • Mesalamine Cap 400mg DR (Quantity Level Limit)
  • Penicillamine Capsule
  • Sildenafil Sus 10mg/ml (Prior Authorization Required)

Removals:

  • Benziq Wash Liq 5.25%
  • Bio-Statin Cap 1000000
  • Bio-Statin Cap 500000 U
  • Bio-Statin Pow
  • Bocasal Pow
  • Calcium Carb Pow Ppt/Heav
  • Cuprimine Capsule
  • Delzicol Cap 400mg DR
  • Ergocal Cap 2500unit
  • Fluorabon Dro
  • Fluoroplex Cre 1%
  • Flura-Drops Dro 4drp=1mg
  • Gentamicin Pow Sulfate
  • Homatropine Sol 5% Op
  • Nature-Throi Tab 2gr
  • Revatio Sus 10mg/ml
  • Sod Fluoride Tab 0.5mg F
  • Sod Fluoride Tab 1mg F
  • Suprax Cap 400mg
  • Tarceva Tab 150mg

Other Updates:

  • None

 

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

Additions:

  • None

Removals:

  • None

Other Updates:

  • None

 

June 2019

Title 19/21 SMI Drug List Updates:

Additions:

  • Docosanol Cream 10%
  • Melatonin Tab 1 Mg
  • Melatonin Tab 3 Mg
  • Melatonin Tab 5 Mg

Removals:s

  • Abreva Cream 10%

Other Updates:

  • None

 

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

Additions:

  • Melatonin Tab 1 Mg
  • Melatonin Tab 3 Mg
  • Melatonin Tab 5 Mg

Removals:

  • None

Other Updates:

  • None

 

May 2019

Title 19/21 SMI Drug List Updates:

Additions:

  • Concerta Tab ER (Age Limit, Quantity Limit)
  • Erythrom Eth Sus 400/5ml
  • Ranolazine Tab 1000mg ER (Prior Authorization Required)
  • Sirolimus Sol 1mg/ml

Removals:

  • EryPed 400 Sus 400/5ml
  • Methylphenidate Tab ER
  • Methylphenidate Tab ER
  • Prochlorperazine Maleate Tab 10 Mg (Base Equivalent)
  • Prochlorperazine Maleate Tab 5 Mg (Base Equivalent)
  • Prochlorperazine Suppos 25 Mg
  • Ranexa Tab 1000mg ER
  • Rapamune Sol 1mg/ml

Other Updates:

  • None

 

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

Additions:

  • Concerta Tab ER

Removals:

  • Methylphenidate Tab ER

Other Updates:

  • None

 

April 2019

Title 19/21 SMI Drug List Updates:

Additions:

  • Ranolazine Tab ER 500mg (Prior Authorization)
  • Ritalin LA Cap 20mg, 30mg, 40mg (Age Limit, Quantity Level Limit)
  • Treprostinil Sol 1mg/mL, 2.5mg/mL, 5mg/mL, 10mg/mL (Prior Authorization)

Removals:

  • Ranexa Tab ER 500mg
  • Remodulin Sol 1mg/mL, 2.5mg/mL, 5mg/mL, 10mg/mL

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

Additions:

  • Ritalin LA Cap 20mg, 30mg, 40mg (Age Limit, Quantity Level Limit)

Removals:

  • None

 

 

March 2019

Title 19/21 SMI Drug List Updates:

Additions:

  • Cinacalcet tablet added with PA
  • Aminocaproic acid tablet
  • Carbidopa 25mg tablet
  • Toremifene tablet added with PA
  • Mesalamine 1000mg Suppositories added with QLL (30/30days)
  • Clonidine 0.1mg ER tablet added with QLL (120/30 days) and PA < 6 years of age

Removals:

  • Sensipar
  • Amicar
  • Fareston
  • Canasa Suppositories
  • Norethindrone- ethinyl estradiol- ferrous fumarate 1-20 mg-mcg (24) tablets
  • Kapvay

 

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

Additions:

  • Clonidine 0.1mg ER tablet added with QLL (120/30 days) and PA < 6 years of age

Removals:

  • Kapvay

 

February 2019

Title 19/21 SMI Drug List Updates:

Additions:

  • Calcipotriene cre 0.005% QLL added (200gm/30days)
  • Calcipotriene oint 0.005% QLL added (200gm/30days)
  • Calcipotriene soln 0.005% (50 mcg/ml) QLL added (200ml/30days)
  • Clonidine HCL ER 0.1mg Tab
  • Flebogamma added with PA (must be filled at Contracted Home Infusion Pharmacy)
  • Gammagard added with PA (must be filled at Contracted Home Infusion Pharmacy)
  • Gammaked added with PA (must be filled at Contracted Home Infusion Pharmacy)
  • Gamunex-C added with PA (must be filled at Contracted Home Infusion Pharmacy)
  • Jardiance PA added
  • Nitrofurantoin Suspension PA > 12 years added
  • Prenatal mv & min w/fe fumarate-fa-dha 28-0.8-200mg pack added with QLL (100/90 days)
  • Prenatal vit w/ docusate-fe fumarate-folic acid 29-1mg tab added with QLL (100/90 days)
  • Prenatal vit w/ ferrous fumarate-folic acid 27-0.8mg tab added with QLL (100/90 days)
  • Prenatal vit w/ ferrous fumarate-folic acid 27-1mg tab added with QLL (100/90 days)
  • Prenatal vit w/ ferrous fumarate-folic acid 28-1mg tab added with QLL (100/90 days)
  • Prenatal vit w/ ferrous fumarate-folic acid 29-1mg chew tab added with QLL (100/90 days)
  • Prenatal vit w/ ferrous fumarate-folic acid 29-1mg tab added with QLL (100/90 days)
  • Prenatal without a vit w/ fe fumarate-folic acid 29-1mg chew tab added with QLL (100/90 days)
  • Prenatal without a vit w/ fe fum-iron polysacch complex –fa 130-92.4-1mg cap added with QLL (100/90 days)
  • Prenatal without a vit w/ fe fum-iron polysacch complex –fa 20-20-1.25mg cap added with QLL (100/90 days)
  • Segluromet added with ST and QLL (60/30 days
  • Steglatro added with ST and QLL (30/30days)

Removals:

  • Condolyx gel
  • Dihydroergotamine Nasal Solution
  • Elidel Cream 1%
  • Ergomar SL Tablet
  • Invokana tablet
  • Invokanamet tablet
  • Jardiance ST removed
  • Kapvay ER 0.1mg Tab
  • Levonor/ethi tab estradio
  • Lidocaine/hc kit 20x7gm
  • Lidocaine/hc kit 3%-1%
  • Lo Loestrin tablet
  • Nitro-bid 2% packets
  • Prenatal multivitamins & minerals w/ l-methylfolate-fa 0.6-0.4mg chew tab
  • Prenatal mv & min w/fe polysaccharide complex-fa-dha 29-1mg & 250mg pack
  • Prenatal vit w/ ferrous fumarate-folic acid 65-1mg tab
  • Prenatal vit w/ ferrous fumarate-l methylfolate-folic acid 27-0.6-0.4mg tab
  • Prenatal vit w/ iron carbonyl-fe aspart glyc-fa-omega 3 27-1mg cap
  • Prenatal vit w/ iron carbonyl-folic acid 50-1.25mg tab
  • Prenatal vit w/ iron polysaccharide complex-folic acid 29-1 chew tab
  • Prenatal w/o vit a w/ fe carbonyl-fe asp glyc-methfol-fa-dha 18-0.6-0.4-350mg cap
  • Prenatal w/o vit a w/ fe carbonyl-fe gluconate-dss-fa-dha 27-1mg & 250mg pack
  • Prenatal w/o vit a w/ fe fumarate-dss-fa-dha 27-1.25-300mg cap
  • Prenatal without a w/ fe fumarate-l methylfolate-fa-dha 27-0.6-0.4-300mg cap
  • Prenatal without a w/ fe fumarate-l methylfolate-fa-omega 3 28-0.6-0.4-340mg cap
  • Synjardy and Synjardy XR tablet
  • Terconazole vaginal suppos 80 mg
  • Trimethobenzamide hcl cap 300 mg

 

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

Additions:

  • None

Removals:

  • None

 

January 2019

Title 19/21 SMI Drug List Updates:

Additions:

  • Celecoxib 50mg and 100mg QLL added (60/30 days)

Removals:

  • None

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

Additions:

  • None

Removals:

  • None

 

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:

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

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:

  • Acebutolol
  • Aclometasone
  • Adcirca
  • Capex shampoo
  • Cardura XL
  • Copaxone 40mg
  • Desonide
  • Diltiazem 24hr ER tablet
  • Diltiazem IR and ER QLL removed
  • Fluocinolone cream, solution
  • Griseofulvin ultramicrosize
  • Hydrocortisone butyrate
  • Hydrocortisone valerate
  • Isradipine
  • Itraconazole
  • Ketoconazole
  • MatzimLA
  • Methylphenidate chewable tablet
  • Nicardipine
  • Nimodipine
  • Nisoldipine
  • Noxafil suspension
  • Pindolol
  • Sporanox solution
  • Strattera
  • Timolol tablet
  • Voriconazole

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

Over-the-counter product list

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. (Find a network pharmacy)
  • 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.

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.

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.

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.

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.

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 Mercy Care's Patient Checklist for more tips to prepare you for a doctor’s visit.