Pharmacy

Absolute Total Care is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Absolute Total Care members. Absolute Total Care covers prescription medications and certain over-the-counter medications with a written order from an Absolute Total Care provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.

Use our Medicaid Preferred Drug List to find more information on the drugs that are covered.

Effective May 1, 2015: Copays will be removed for certain asthma, COPD and diabetes medications. View our Asthma, COPD and Diabetes Preferred Drug List Medications to view the list of qualifying drugs.

Biopharmaceutical Pharmacy Program

2017 Preferred Drug List Updates

• Q1

2016 Preferred Drug List Updates

• Q4
• Q3
• Q2
• Q1

2015 Preferred Drug List Updates

• Q4
• Q1-Q3

2014 Preferred Drug List Updates

• All
• Medicaid Specialty Preferred Drug List
• Suboxone Prior Authorization Form
• Pharmacy Preferred Drug List Change Request Form

AcariaHealth

• Provider Announcement

Envolve Pharmacy Solutions

• Universal Retail Medication Prior Authorization Form
• ATC Appropriate Use and Safety Edits

Contact Information:
Prior Authorization Fax 1-866-399-0929
Prior Authorization Phone 1-866-399-0928
Clinical Hours 11 a.m. to 8 p.m. (EST), Monday through Friday

Specialty Medications

• Specialty Drug Prior Authorization Form
• Synagis Letter
• Synagis Referral Form: 2016-2017
• Synagis Administration Policy

All prior authorization requests should be faxed to Absolute Total Care at 1-855-865-9469. For more information, call 1-866-433-6041.

17P or Makena

• Makena/17P Prior Authorization Form