Provider Prescription Drugs

About the Formulary

The Formulary is your guide to prescription drugs covered for the ACA StandardHealth with Health Choice plans. The Formulary is organized into one of seven categories or “tiers.” This means the member cost share for covered prescription medications varies depending on which tier a medication is in. Each tier may have a different cost share. Medications are assigned to tiers based on their quality, value, and effectiveness.

Products are listed by brand or generic name. Brand name products are not included as a reference, please confirm if generic substitute is available (Drugs.com – Prescription Drug Information) and search the formulary for the generic name to assist in product recognition. Unless exceptions are noted, generally all dosage forms and strengths of the drug cited are covered.

Here is how you can view or search the Formulary:

Additional information about your benefits, including the formulary, other resources, and pharmacy coverage guidelines for precertification, may be found at: Pharmacy | Affordable Care Act (ACA) Plans | BCBSAZ (azblue.com).

To get updated information about the drugs covered by ACA StandardHealth with Health Choice plans, call us at 866-325-1794 toll-free 24/7/365. Call the number on member ID card Monday through Friday (except holidays), 8:30 a.m. – 4:30 p.m. TTY/TDD users can call 711.

Requirements or Limits on Coverage

Some covered drugs may have additional requirements or limits on coverage. Please refer to the current formulary for guidance.

Prior Authorization

We may require prior authorization for certain drugs. You will need to get approval from ACA StandardHealth with Health Choice for drugs noted with a “PA” on the drug list or for any drugs not listed in the formulary. If you do not get approval, we may not cover the cost of the drug. Refer to the current formulary for instruction on prior authorization submission and non-formulary medications.

Note: Medical prior authorization requests (including J-code) may be submitted via the Provider Portal.