Pharmacy Discount Program
AHCCCS Managed Care Prescription Benefit
The AHCCCS program is a Medicaid managed health care
delivery model. The State awards contracts, based on
competitive bids, to a variety of managed care
organizations (MCOs). The MCOs are paid a monthly
prospective capitation for each enrolled member. The MCO
is then at financial risk to deliver the necessary
services within the capitated amount. The prescription
benefit is included in the capitation paid to the MCOs.
Within broad state and federal guidelines, the MCOs have
discretion to independently set formularies, prior
authorization policies, establish a pharmacy provider
network, and negotiate the reimbursement rate for
pharmacy services. AHCCCS does not mandate a statewide
formulary. Arizona does not participate in the Medicaid
Drug Rebate Program due to the CMS exclusion of members
enrolled in MCOs that include the prescription drug
benefit in capitation.
A list of the AHCCCS MCOs and other information is
available on this website at
https://scertsrv.azahcccs.gov/healthplanlinks/.
AHCCCS Fee-For-Service Prescription Benefit
Services for a relatively small percentage of AHCCCS
members are reimbursed on a fee-for-service (FFS) basis.
The prescription benefit for these members is
administered through a contract with a prescription
benefit management company, RxAmerica. RxAmerica
administers an AHCCCS FFS formulary and the pharmacy
provider network. Services for the majority FFS members
are available from other providers, primarily Indian
Health Service (IHS) facilities. Consequent, in a
typical month, less than 3% of the FFS members
(2500-3000) utilize the prescription benefit services
administered by RxAmerica.
For questions regarding the Arizona
Prescription Drug Discount Program, call the RxAmerica
Help Desk at 1-800-770-8014. Or visit their website, http://www.rxamerica.com/.
Related Information:
The
specific link to the Prescription Drug and Other
Assistance Programs section where the drug card
information will be housed is: http://www.medicare.gov/AssistancePrograms/home.asp
With her first Executive Order, Governor Napolitano
created the Arizona Prescription Drug Discount Card
program, which offers significant discounts to
Medicare-eligible seniors and disabled Arizonans who pay
the cash price for medications.
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