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Pharmacy Resources for Providers | Ambetter from Arizona Complete Health
Pharmacy
We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter members. Use our Preferred Drug List to find more information on the drugs that Ambetter covers.
- 2021 Preferred Drug List (PDF)
- 2020 Preferred Drug List (PDF)
- 2019 Preferred Drug List (PDF)
- 90-Day Extended Supply Medications (PDF)
PA Forms
- Prior Authorization Request Form for Non-Specialty Drugs (PDF)
- Prior Authorization Request Forms for Specialty Drugs
- 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.