Pharmacy
Arkansas Total Care provides high-quality and cost-effective drug therapy to our members. Arkansas Total Care covers prescription medications and some over-the-counter medications approved by providers. The pharmacy program does not cover all medications. Some medications need prior authorization, and some may have limitations.
Effective January 1, 2024, Arkansas Total Care will be changing our Pharmacy Benefits Manager (PBM) to Express Scripts®. See below for new pharmacy processing information.
Pharmacy Services
For questions, please contact Pharmacy Services 24/7 at 1-833-587-2011.
Prior Authorization
Arkansas Total Care’s preferred method for submitting pharmacy prior authorization requests is through CoverMyMeds®.
CoverMyMeds is the fast and simple way to review, complete, and track prior authorization requests. Their electronic submissions process is safe, secure, and available for providers and their staff to use at no cost.
Here are more resources if you cannot access the Pharmacy Portal:
- Arkansas Medicaid Preferred Drug List — The Preferred Drug List (PDL) (PDF) is the list of drugs covered by Arkansas Total Care. We work with providers and pharmacists to create this list. Our goal is to ensure the pharmacy benefit covers prescription medications. These medications are for a variety of conditions and diseases. The PDL applies to drugs you get at retail pharmacies. Please direct all overrides to the Pharmacy Help Desk: 1-833-750-4324 (Rx BIN: 003858).
- Healthcare Providers | Express Scripts
- Prior Authorization Request Form for Prescription Drugs (PDF)
- Opioid Resources for Prescribers
- Arkansas Medicaid Pharmacy Program Provider Memo — To access memos, under “TAG” on the left-hand side of the page, select memorandums.
Effective January 1, 2024: Preferred Blood Glucose Meters and Supplies
Please note that prior authorization may be required for certain products. Traditional insulin pumps requiring tubing and cannula-type supplies will remain a medical benefit.
Manufacturer | Product Name | Limitation |
---|---|---|
LifeScan | OneTouch® Ultra® 2 Glucose System | One meter per 365 days |
LifeScan | OneTouch Verio Flex® System Kit | One meter per 365 days |
LifeScan | OneTouch Verio Reflect® System | One meter per 365 days |
Abbott Diabetes Care | FreeStyle Freedom Lite Meter | One meter per 365 days |
Abbott Diabetes Care | FreeStyle InsuLinx Glucose System | One meter per 365 days |
Abbott Diabetes Care | FreeStyle Lite Meter | One meter per 365 days |
Abbott Diabetes Care | Precision Xtra Monitor | One meter per 365 days |
Abbott Diabetes Care | FreeStyle Precision Neo | One meter per 365 days |
Manufacturer | Product Name | Limitation without CGM |
---|---|---|
LifeScan | OneTouch Verio Test Strips | 200 per 31 days |
LifeScan | OneTouch Ultra Test Strips | 200 per 31 days |
Abbott Diabetes Care | FreeStyle Lite Test Strips | 200 per 31 days |
Abbott Diabetes Care | FreeStyle InsuLinx Test Strips | 200 per 31 days |
Abbott Diabetes Care | Precision Xtra Test Strips | 200 per 31 days |
Abbott Diabetes Care | FreeStyle Precision Neo Test Strips | 200 per 31 days |
Abbott Diabetes Care | FreeStyle Test Strips | 200 per 31 days |
ANY MANUFACTURER | Insulin Syringes (with WAC pricing) | N/A |
ANY MANUFACTURER | Insulin Pen Needles (with WAC pricing) | N/A |
ANY MANUFACTURER | Lancets | 200 per 31 days |
ANY MANUFACTURER | Lancing Device | One per 186 days |
ANY MANUFACTURER | Calibration Solution | One bottle per 31 days |
ANY MANUFACTURER | Urine Reagent Strips/Tabs | 200 per 31 days |
Manufacturer | Product Name | Limitation |
---|---|---|
Dexcom | Dexcom G6 Receiver | One per 365 days |
Dexcom | Dexcom G6 Sensor | Three per 30 days |
Dexcom | Dexcom G6 Transmitter | One every 90 days |
Dexcom | Dexcom G7 Receiver | One per 365 days |
Dexcom | Dexcom G7 Sensor | Three per 30 days |
Abbott Diabetes Care | FreeStyle Libre 2 Sensor | Two per 28 days |
Abbott Diabetes Care | FreeStyle Libre 2 Reader | One per 365 days |
Abbott Diabetes Care | FreeStyle Libre 3 Sensor | Two per 28 days |
Manufacturer | Product Name | Limitation |
---|---|---|
Insulet | Omnipod® 5 | 15 pods (three boxes) per 30 days |
Insulet | Omnipod 5 G6 Kit | One per 365 days |
Insulet | Omnipod DASH® | 15 pods (three boxes) per 30 days |
Insulet | Omnipod DASH Kit | One per 365 days |
Insulet | Omnipod GO™ (All Strengths) | 15 pods (three boxes) per 30 days |
MannKind | V-Go® (All Strengths) | 30 (one box) per 30 days |