We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter from Arizona Complete Health members. Use our Preferred Drug List to find more information on the drugs that Ambetter from Arizona Complete Health covers.

• 2023 Formulary/Prescription Drug List(PDF)
  
• 2022 Preferred Drug List (PDF)
• 90-Day Extended Supply Medications (PDF)

PA Forms

• CoverMyMeds
• Prior Authorization Fax Form
  
• 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.