Blue cross blue shield of az prescription coverage

COVID-19 Vaccines and Tests Are Free and Widely Available
Safe, effective, and free vaccines are widely available at doctor’s offices, pharmacies, and numerous other locations around the state. Arizonans age 5 and older are eligible to receive the vaccine. See our vaccine page to find locations.

COVID-19 testing is also widely available, please visit azdhs.gov. Please help prevent the spread of COVID-19 by getting tested if you have symptoms and isolating if you test positive.
COVID-19 test reimbursement information
COVID-19 free tests from federal government information

FLU SHOT

Please see the flu shot page on wellness.az.gov/flushot.

ABOUT PHARMACY COVERAGE

MedImpact is the prescription drug provider for all medical Plans.
All prescriptions must be filled at an in-Network pharmacy by presenting your medical insurance card.
Your pharmacy coverage is included in your medical coverage.
Pharmacy contact information is found on the back of all medical provider ID cards.
MEDIMPACT PHARMACY: 888-648-6769 | Rx BIN: 003585 | Rx PCN: 28914 | medimpact.com/plan/adoa/ | Generic Login to Preview Formulary - Username: EPOADOA3, Password: [email protected]
MEDIMPACT SPECIALTY DIRECT PHARMACY: 877-391-1103
MEDIMPACT DIRECT MAIL: 855-873-8739

MEDIMPACT PHARMACY MEMBER PORTAL

Real-time access to personalized healthcare and ﬁnancial information so you can better manage your budget and your healthcare.

Table of Contents Show

COVID-19 Vaccines and Tests Are Free and Widely Available
ABOUT PHARMACY COVERAGE
MEDIMPACT PHARMACY MEMBER PORTAL
FORMULARY LISTS
GUIDELINES & LIMITS
CONTROLLING YOUR COSTS
MAIL ORDER PHARMACY
CHOICE 90 Rx
iRx DISCOUNT PROGRAM
GENERIC vs. BRAND NAME DRUGS
TOBACCO CESSATION
REIMBURSEMENT
What are Tier 4 prescriptions?
What is Tier 1 prescription coverage?
Is GoodRx a Part D plan?
What is the list of drugs covered by insurance called?

Benefit Highlights – View your copay amounts and other pharmacy benefit information.
Prior Authorization Status – View the status of your prior authorization requests
- Remaining re-fills and expiration dates
- Complete prior authorization history
Drug Price Check – Make informed drug choices and compare drug prices.
Drug Information – Search drugs, check drug interactions, identify pills.
PersonalHealth Rx® – Print your drug history for a physician visit or tax reporting.
Pharmacy Locator – Find a participating network pharmacy near you, including preferred pharmacies that may have better pricing for your plan benefits, 24-hour pharmacies, and e-prescribing participants.
Registration Required – For access to the tools, you need to manage your pharmacy beneﬁt. Please note that you will need to re-register if you have changed medical carriers.

Website

medimpact.com/plan/adoa | Generic Login to Preview Formulary - Username: EPOADOA3, Password: [email protected]

FORMULARY LISTS

The formulary is the list of medications chosen by a committee of doctors and pharmacists to help you maximize the value of your prescription benefit. These generic and brand-name medications are available at a lower cost. The use of non-preferred medications will result in a higher copay. Sharing the formulary with your doctor helps ensure you are getting the best value, saving money for you and the State of Arizona.

Changes to the formulary can occur during the Plan Year on a quarterly basis. Medications that no longer offer the best therapeutic value for the Plan are removed from the formulary. Ask your pharmacist to verify the current cost or copay amount when your prescription is filled. Members can log into the MedImpact Pharmacy website for complete formulary information.

Drug List	description
Preferred Drug List	The Preferred Drug List (PDL) lists commonly prescribed medications within select classes of drugs covered on your formulary. The formulary is updated regularly and is subject to change without advance notice.
Specialty Drug List	Certain medications used for treating chronic or complex health conditions are handled through the MedImpact Program. This program assists you with monitoring your medication needs and provides patient education. The program includes monitoring of specific injection drugs and other therapies requiring complex administration methods and special storage, handling, and delivery. The formulary is updated regularly and is subject to change without advance notice. Specialty medications are limited to a 31-day supply and may be obtained only at a participating retail pharmacy or through the MedImpact Specialty Pharmacy. Members may enroll in services by calling 877-391-1103 (TTY dial 711) or email us at [email protected].
Essential Health Benefits List	Under the Affordable Care Act, certain preventive medications are covered at zero-copay under the pharmacy benefit as needed in compliance with healthcare reform requirements under the Affordable Care Act. State-specific requirements may vary.
Safe Harbor Preventive Drug List	Preventive Drugs are prescribed for people at risk for certain diseases but do not yet show signs and symptoms. They are used to prevent a disease or condition, a complication from a disease, or prevent a recurrence of a condition. They are typically not used to treat an existing illness. You will not pay the full cost of these drugs, and the copays will not accumulate to meet the HSA deductible. Only the normal flat dollar copay will apply to these drugs, as shown under Copays below.

GUIDELINES & LIMITS

Some drugs may have additional requirements or limits on coverage. These requirements may include:

Prior Authorization - Prescriptions for certain medications may require clinical approval before they can be filled, even with a valid prescription. These prescriptions may be limited to quantity, frequency, dosage or may have age restrictions. You, your local pharmacy, or your physician may initiate the authorization process by contacting MedImpact. Learn more about Prior Authorization, including processing times, in this flyer.
Step Therapy Program - The program promotes the use of safe, cost-effective, and clinically appropriate medications. This requirement encourages you to try less costly but just as effective drugs before the Plan covers another drug. For example, if Drug A and Drug B treat the same medical condition, the Plan may require you to try Drug A first. If Drug A does not work for you, the Plan will then cover Drug B. This requirement to try a different drug first is called “step therapy.” Learn more about Step Therapy in this flyer.
Quantity Limits - For certain drugs, there are limits on the amount of the drug that will be covered.
Coordination of Benefits - Benefit Options does not coordinate pharmacy benefits.
Out-of-Network & International - The cost of prescriptions filled out-of-Network will not be reimbursed. No international pharmacy services are covered. Fill prescriptions before your trip and take your prescriptions with you. No coverage for a medication that is lost, stolen, or damaged.

CONTROLLING YOUR COSTS
MAIL ORDER PHARMACY
Save money with mail order - receive a three-month supply for the price of a two-month supply.
Mail Order Pharmacy Registration Form
MedImpact Direct Mail Order FAQs
MedImpact Direct Specialty FAQs
CHOICE 90 Rx
Save time and money at the pharmacy - in just one visit, pick up a full three-month supply for the price of two-and-a-half copays.
Choice 90 Rx Information
iRx DISCOUNT PROGRAM
The iRx Program™ may be able to provide a discount on certain brand and generic medications that are not covered by your ADOA pharmacy drug plan.
Present your medical ID card at any participating pharmacy, along with your prescription for the medication.
Savings are applied automatically when the item prescribed qualifies for a discount.
GENERIC vs. BRAND NAME DRUGS
Learn the key information about each type of drug in this flyer.

TOBACCO CESSATION

Smoking cessation help is available at no cost to you. All help services are free and available in English and Spanish. To take the first step toward quitting, call 844-866-3727.

Tobacco Cessation Intro Flyer
Tobacco Drug Coverage Information Flyer

REIMBURSEMENT

Pharmacy Reimbursement Form

COPAYS

	Generic	Preferred Brand Name	Non-Preferred Brand Name
Retail 31-Day Supply	$15	$40	$60
Retail 90-Day Supply	$37.50	$100	$150
Mail Order 90-Day Supply	$30	$80	$120

CONTACT

MedImpact Pharmacy

Rx BIN: 003585 | Rx PCN: 28914
medimpact.com/plan/adoa | Generic Login to Preview Formulary - Username: EPOADOA3, Password: [email protected]
888-648-6769

MedImpact Direct Specialty Pharmacy

Rx BIN: 003585 | Rx PCN: 28914
medimpact.com/plan/adoa | Generic Login to Preview Formulary - Username: EPOADOA3, Password: [email protected]
877-391-1103 (TTY dial 711)
[email protected]

MedImpact Direct Mail

855-873-8739

What are Tier 4 prescriptions?

Tier 1: Least expensive drug options, often generic drugs. Tier 2: Higher price generic and lower-price brand-name drugs. Tier 3: Mainly higher price brand-name drugs. Tier 4: Highest cost prescription drugs.

What is Tier 1 prescription coverage?

Tier 1 - Generic: All drugs in Tier 1 are generic and have the lowest possible copayment. A copayment is a fixed amount you pay when you get a prescription filled or receive other health care services. Drugs listed as Tier 1 are preferred because they offer the best combination of value and effectiveness.

Is GoodRx a Part D plan?

GoodRx is a discount drug program that searches for the lowest price prescription drugs in your area. They also offer manufacturer drug discount coupons when available. GoodRx is not prescription drug insurance and does not replace your Medicare Part D prescription drug plan.

What is the list of drugs covered by insurance called?

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.