Estamos comprometidos con brindar terapia farmacológica apropiada, de alta calidad y rentable a todos los miembros de Ambetter from Arizona Complete Health. Use nuestra Lista de medicamentos preferidos para encontrar más información sobre los medicamentos que Ambetter from Arizona Complete Health cubre.

• Formulario/Lista de medicamentos recetados para 2023 (PDF)
  
• Lista de medicamentos preferidos de 2022 (PDF)
• Suministros de recetas por un período extendido de 90 días (PDF)

PA Forms

• CoverMyMeds
  
• Prior Authorization Request Form for Non-Specialty Drugs (PDF)
• For Medical “J-Code” or “buy-and-bill” prior authorization requests, please submit the request through our Secure Provider Portal.

Oncology Prior Authorization Requests

Pre-approval Process 

The requesting physician must complete an authorization request using one of the following methods: 

• Logging into the NCH Provider Web Portal: https://my.newcenturyhealth.com 
• Calling 1-877-624-8601 (Monday – Friday 5 a.m. to 5 p.m. PST) 
• Faxing the authorization form to 1-877-624-8602 

Please note: 

Inpatient requests for chemotherapy should continue to be submitted via our Secure Provider Portal.

Pharmacy dispensed chemotherapeutic and supportive agents that were previously submitted to Envolve Pharmacy Solutions or CoverMyMeds should be submitted directly to NCH.