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Fillable Printable Ahcccs Preferred Drug Changes

Fillable Printable Ahcccs Preferred Drug Changes

Ahcccs Preferred Drug Changes

Ahcccs Preferred Drug Changes

AHCCCS PREFERRED DRUG LIST CHANGES EFFECTIVE JANUARY 1, 2016
NDC Drug LabelName
Preferred Drug Status
P= Preferred Drug
NP = Non-Preferred Drug
00013264681 GENOTROPIN 12 MG CARTRIDGE P
00013262681 GENOTROPIN 5 MG CARTRIDGE P
00013264902 GENOTROPIN MINIQUICK 0.2 MG P
00013265002 GENOTROPIN MINIQUICK 0.4 MG P
00013265102 GENOTROPIN MINIQUICK 0.6 MG P
00013265202 GENOTROPIN MINIQUICK 0.8 MG P
54868576000 GENOTROPIN MINIQUICK 0.8 MG P
00013265302 GENOTROPIN MINIQUICK 1 MG P
00013265402 GENOTROPIN MINIQUICK 1.2 MG P
00013265502 GENOTROPIN MINIQUICK 1.4 MG P
00013265602 GENOTROPIN MINIQUICK 1.6 MG P
00013265702 GENOTROPIN MINIQUICK 1.8 MG P
00013265802 GENOTROPIN MINIQUICK 2 MG P
00002814801 HUMATROPE 12 MG CARTRIDGE NP
00002814901 HUMATROPE 24 MG CARTRIDGE NP
00002733511 HUMATROPE 5 MG VIAL NP
00002734901 HUMATROPE 5 MG VIAL NP
00002814701 HUMATROPE 6 MG CARTRIDGE NP
00169770521 NORDITROPIN FLEXPRO 10 MG/1.5 P
00169770821 NORDITROPIN FLEXPRO 15 MG/1.5 P
00169770321 NORDITROPIN FLEXPRO 30 MG/3 ML P
00169770421 NORDITROPIN FLEXPRO 5 MG/1.5 P
00169770311 NORDITROPIN NORDIFLEX 30 MG/3 P
50242007301 NUTROPIN AQ 20 MG/2ML PEN CART P
50242007401 NUTROPIN AQ NUSPIN 10 INJECTOR P
50242007601 NUTROPIN AQ NUSPIN 20 INJECTOR P
50242007501 NUTROPIN AQ NUSPIN 5 INJECTOR P
50242004314 NUTROPIN AQ PEN CARTRIDGE P
00781300407 OMNITROPE 10 MG/1.5 ML CRTG NP
00781300426 OMNITROPE 10 MG/1.5 ML CRTG NP
00781300107 OMNITROPE 5 MG/1.5 ML CRTG NP
00781300126 OMNITROPE 5 MG/1.5 ML CRTG NP
00781400436 OMNITROPE 5.8 MG VIAL NP
44087100502 SAIZEN 5 MG VIAL NP
44087108001 SAIZEN 8.8 MG CLICK.EASY CARTG NP
44087108801 SAIZEN 8.8 MG VIAL NP
44087000401 SEROSTIM 4 MG VIAL NP
44087000407 SEROSTIM 4 MG VIAL NP
44087000501 SEROSTIM 5 MG VIAL NP
44087000507 SEROSTIM 5 MG VIAL NP
44087000607 SEROSTIM 6 MG VIAL NP
44087000601 SEROSTIM 6 MG VIAL NP
55566190101 ZOMACTON 10 MG VIAL NP
55566180101 ZOMACTON 5 MG VIAL NP
44087338807 ZORBTIVE 8.8 MG VIAL NP
50242013801 ACTEMRA 162 MG/0.9 ML SYRINGE NP
50242013601 ACTEMRA 200 MG/10 ML VIAL NP
50242013701 ACTEMRA 400 MG/20 ML VIAL NP
50242013501 ACTEMRA 80 MG/4 ML VIAL NP
61755000101 ARCALYST 220 MG INJECTION NP
50474070062 CIMZIA 200 MG VIAL KIT NP
50474071081 CIMZIA 200 MG/ML STARTER KIT NP
50474071079 CIMZIA 200 MG/ML SYRINGE KIT NP
00078063968 COSENTYX 150 MG/ML PEN INJECT NP
00078063997 COSENTYX 150 MG/ML SYRINGE NP
00078063941 COSENTYX 300 MG DOSE-2 PENS NP
00078063998 COSENTYX 300 MG DOSE-2 SYRINGE NP
58406042534 ENBREL 25 MG KIT P
58406042541 ENBREL 25 MG KIT P
58406045501 ENBREL 25 MG/0.5 ML SYRINGE P
58406045504 ENBREL 25 MG/0.5 ML SYRINGE P
58406044501 ENBREL 50 MG/ML SURECLICK SYR P
58406044504 ENBREL 50 MG/ML SURECLICK SYR P
58406043501 ENBREL 50 MG/ML SYRINGE P
54868544400 ENBREL 50 MG/ML SYRINGE P
58406043504 ENBREL 50 MG/ML SYRINGE P
64764030020 ENTYVIO 300 MG VIAL NP
00074634702 HUMIRA 10 MG/0.2 ML SYRINGE P
00074937402 HUMIRA 20 MG/0.4 ML SYRINGE P
00074433902 HUMIRA 40 MG/0.8 ML PEN P
00074433971 HUMIRA 40 MG/0.8 ML PEN P
00074379902 HUMIRA 40 MG/0.8 ML SYRINGE P
00074433906 HUMIRA CROHNS STARTER PACK P
00074379903 HUMIRA PEDIATRIC CROHN'S START P
00074379906 HUMIRA PEDIATRIC CROHN'S START P
00074433907 HUMIRA PEN PSORIASIS START PK P
00078058261 ILARIS 180 MG VIAL NP
66658023407 KINERET 100 MG/0.67 ML SYRINGE NP
66658023401 KINERET 100 MG/0.67 ML SYRINGE NP
66658023428 KINERET 100 MG/0.67 ML SYRINGE NP
00003218811 ORENCIA 125 MG/ML SYRINGE NP
00003218710 ORENCIA 250 MG VIAL NP
59572063255 OTEZLA 28 DAY STARTER PACK NP
59572063106 OTEZLA 30 MG TABLET NP
59572063128 OTEZLA 30 MG TABLET NP
59572063027 OTEZLA STARTER PACK NP
57894003001 REMICADE 100 MG VIAL NP
57894007102 SIMPONI 100 MG/ML PEN INJECTOR NP
57894007101 SIMPONI 100 MG/ML SYRINGE NP
57894007002 SIMPONI 50 MG/0.5 ML PEN INJEC NP
57894007001 SIMPONI 50 MG/0.5 ML SYRINGE NP
57894035001 SIMPONI ARIA 50 MG/4 ML VIAL NP
57894006003 STELARA 45 MG/0.5 ML SYRINGE NP
57894006103 STELARA 90 MG/ML SYRINGE NP
00069100101 XELJANZ 5 MG TABLET NP
52054080302 ADRENACLICK 0.15 MG AUTO-INJCT NP
52054080402 ADRENACLICK 0.3 MG AUTO-INJECT NP
00024583102 AUVI-Q 0.15 MG AUTO-INJECTOR NP
00024583302 AUVI-Q 0.3 MG AUTO-INJECTOR NP
54505010102 EPINEPHRINE 0.15 MG AUTO-INJCT P
54505010101 EPINEPHRINE 0.15 MG AUTO-INJCT P
54505010201 EPINEPHRINE 0.3 MG AUTO-INJECT P
54505010202 EPINEPHRINE 0.3 MG AUTO-INJECT P
54569625700 EPIPEN 2-PAK 0.3 MG AUTO-INJCT P
54868280401 EPIPEN 2-PAK 0.3 MG AUTO-INJCT P
49502050002 EPIPEN 2-PAK 0.3 MG AUTO-INJCT P
54868481900 EPIPEN JR 2-PAK 0.15 MG INJCTR P
54569625800 EPIPEN JR 2-PAK 0.15 MG INJCTR P
49502050102 EPIPEN JR 2-PAK 0.15 MG INJCTR P
10122082056 BETHKIS 300 MG/4 ML AMPULE P
10122082004 BETHKIS 300 MG/4 ML AMPULE P
10122082028 BETHKIS 300 MG/4 ML AMPULE P
61958090101 CAYSTON 75 MG INHAL SOLUTION NP
24492085056 KITABIS PAK 300 MG/5 ML P
00078049461 TOBI 300 MG/5 ML SOLUTION NP
00078049471 TOBI 300 MG/5 ML SOLUTION NP
00078063056 TOBI PODHALER 28 MG INHALE CAP NP
00078063011 TOBI PODHALER 28 MG INHALE CAP NP
00078063019 TOBI PODHALER 28 MG INHALE CAP NP
00078063035 TOBI PODHALER 28 MG INHALE CAP NP
65162091446 TOBRAMYCIN 300 MG/5 ML AMPULE NP
00093408563 TOBRAMYCIN 300 MG/5 ML AMPULE NP
00781717156 TOBRAMYCIN 300 MG/5 ML AMPULE NP
00781717184 TOBRAMYCIN 300 MG/5 ML AMPULE NP
17478034038 TOBRAMYCIN 300 MG/5 ML AMPULE NP
24492089999 TOBRAMYCIN PAK 300 MG/5 ML NP
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