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.

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:

  • 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

 

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:

  • Pexeva QLL removed
  • Silenor
  • Meprobamate
  • Estazolam
  • Flurazepam
  • Eszopiclone
  • Triazolam
  • Rozerem PA removed
  • Zaleplon
  • Zolpidem ER
  • Intermezzo SL/ Edular
  • Zolpimist

 

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:

  • Albuterol tablets, IR and ER
  • Amcinonide cream/lotion
  • Betopic S ophthalmic
  • Brimonidine 0.15% ophthalmic
  • Cefaclor ER
  • Estrace vaginal cream
  • FML forte ophthalmic
  • Gatifloxacin 0.5% ophthalmic solution
  • Hydromorphone suppositories
  • Neomycin/polymyxin HC ophthalmic
  • One Touch Verio High
  • Oxymorphone IR
  • Pen Needles (any brand other than BD)
  • Pramosone-HC 1%-1% topical cream
  • Prednicarbate topical
  • Reyataz tablets
  • Sustiva
  • Terbutaline tablets
  • Viread

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:

  • Epclusa
  • Epinephrine by Impax Labs
  • Epipen, Epipen Jr
  • Harvoni
  • Hysingla
  • Oxycontin
  • Technivie
  • Viekiera Pak
  • Viekiera Pak XR
  • Zepatier

Other Updates:

  • Adcirca (Removed Quantity Level Limit)
  • Benzonatate (Removed Quantity Level Limit)
  • Brilinta (Removed Quantity Level Limit)
  • Brompheniramine-dm-pseudoephedrine (Removed Quantity Level Limit)
  • Budesonide (Removed Quantity Level Limit)
  • Clopidogrel (Removed Quantity Level Limit)
  • Cyclobenzaprine 5mg, 10mg (Removed Quantity Level Limit)
  • Descovy (Removed Quantity Level Limit)
  • Donepezil/ donepezil ODT (Removed Quantity Level Limit)
  • Ella (Removed Quantity Level Limit)
  • Emend (Changed Quantity Level Limit)
  • Fluocinonide 0.05% gel, ointment (Removed Quantity Level Limit)
  • Foradil (Removed Quantity Level Limit)
  • Gabapentin (Removed Quantity Level Limit)
  • Galantamine (Removed Quantity Level Limit)
  • Gemfibrozil (Removed Quantity Level Limit)
  • Genvoya (Removed Quantity Level Limit)
  • Imbruvica (Removed Quantity Level Limit)
  • Isentress tabs, chew tabs, suspension (Removed Quantity Level Limit)
  • Lamivudine (Removed Quantity Level Limit)
  • Lansoprazole (Rx) (Removed Quantity Level Limit)
  • Letairis (Removed Quantity Level Limit)
  • Levonorgestrel 0.75mg (Removed Quantity Level Limit)
  • Lidocaine-prilocaine topical (Removed Quantity Level Limit)
  • Lisinopril (Removed Quantity Level Limit)
  • Methocarbamol (Removed Quantity Level Limit)
  • Nexavar (Removed Quantity Level Limit)
  • Next Choice, Next Choice One Dose (Removed Quantity Level Limit)
  • Nisoldipine (Removed Quantity Level Limit)
  • Omeprazole (Rx) (Removed Quantity Level Limit)
  • Pantoprazole (Removed Quantity Level Limit)
  • Pioglitazine/ pioglitazine-metformin (Removed Quantity Level Limit)
  • Plan B One Step (Removed Quantity Level Limit)
  • Raloxifene (Removed Quantity Level Limit)
  • Revlimid (Removed Quantity Level Limit)
  • Rivastigamine (Removed Quantity Level Limit)
  • Ropinirole (Removed Quantity Level Limit)
  • Sildenafil (Removed Quantity Level Limit)
  • Spiriva (Removed Quantity Level Limit)
  • Stribild (Removed Quantity Level Limit)
  • Sutent (Removed Quantity Level Limit)
  • Tamsulosin (Removed Quantity Level Limit)
  • Tasigna (Removed Quantity Level Limit)
  • Terazosin (Removed Quantity Level Limit)
  • Thalomid (Removed Quantity Level Limit)
  • Tivicay (Removed Quantity Level Limit)
  • Tobradex ointment (Removed Quantity Level Limit)
  • Tracleer (Removed Quantity Level Limit)
  • Trospium (Removed Quantity Level Limit)
  • Tykerb (Removed Quantity Level Limit)
  • Valsartan/ Valsartan HCTZ (Removed Quantity Level Limit)
  • Verapamil IR (Removed Quantity Level Limit)
  • VIread (Removed Quantity Level Limit)
  • Votrient (Removed Quantity Level Limit)
  • Zafirlukast (Removed Quantity Level Limit)
  • Zonisamide (Removed Quantity Level Limit)

 

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

  • No Monthly Updates

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.

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