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.
Ambetter Pharmacy Requests **Will open into new window
Use our Medicaid Preferred Drug Lists for more information on the drugs that are covered:
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.
- 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 & 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: 1-800-460-8988
- Cover My Meds Prior Auth Forms
- Universal Retail Medication Prior Authorization Form (PDF)
- Appropriate Use and Safety Edits April 2022 (PDF)
Contact Information
– Prior Authorization Fax: 1-833-982-4001
– Prior Authorization Phone: 1-866-399-0928
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.
2023 Preferred Drug List Updates
- Drug List Updates - Effective January 1, 2023 (PDF)
- Drug List Updates - Effective March 1, 2023 (PDF)
- Drug List Updates - Effective June 1, 2023 (PDF)
- Drug List Updates - Effective July 7, 2023 (PDF)
- Drug List Updates - Effective September 1, 2023 (PDF)
- Drug List Updates - Effective October 1, 2023 (PDF)
2022 Preferred Drug List Updates