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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 Lists for more information on the drugs that are covered:

2022 Preferred Drug List Updates

2021 Preferred Drug List Updates

New Century Health - Oncology

All oncology-related chemotherapeutic drugs and supportive agents will require prior authorization from New Century Health (NCH) before being administered in a physician’s office, outpatient hospital, or ambulatory setting.

This process applies to both Medical Benefit (Buy and Bill Request) AND Pharmacy Services (Retail Pharmacy)

Pre-Approval Process

The requesting physician must complete an authorization request using one of the following methods:

  • Log in to the NCH Provider Web Portal at https://my.newcenturyhealth.com.
  • Call 1-888-999-7713 and select option 1, from 8 a.m. to 8 p.m. EST, Monday through Friday.

General New Century Health Information

Medical Benefit - Buy and Bill Request

Medical Benefit Buy & Bill requests are for medications that will be administered by a provider.

Examples include:

   – Infusions in a provider’s office/outpatient setting
   – Medications that will be administered in a home setting
   – Injectables

To ensure timely processing of prior authorization requests, all supporting clinical information is required. Clinical information includes but is not limited to labs, radiology, clinical notes and utilization of previous medication for step therapy. For chemotherapy medication requests, include regimen and anticipated dates of service.

Lack of clinical information may result in delayed and/or denial of prior authorization request.

Contact Information

    – Prior Authorization Fax: 1-855-865-9469
    – Prior Authorization Phone: 1-866-433-6041

Pharmacy Services - Retail Pharmacy

Contact Information

    – Prior Authorization Fax: 1-833-982-4001
    – Prior Authorization Phone: 1-866-399-0928

17P or Makena - Medical Benefit or Retail Pharmacy

Synagis (RSV) - Medical Benefit or Retail Pharmacy

General Pharmacy Information

  • Copays will be removed for certain asthma, COPD and diabetes medications. View our Asthma, COPD and Diabetes Preferred Drug List Medications (PDF) to view the list of qualifying drugs.
  • Absolute Total Care will waive copays for all members who get a prescription for a smoking cessation medication that is on the Preferred Drug List.
  • All opioids (excluding exemptions) will be limited to an initial seven (7) day supply.