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.
Pharmacy Benefit Manager (PBM): Envolve Pharmacy Solutions
Envolve Pharmacy Solutions, Arkansas Total Care's PBM, administers the medication prior authorization process.
Click on the link below to access the Arkansas PDL/PASSE Drug Formulary including:
- The PASSE maximum allowable cost (MAC) pricing
- Provider guideline for pharmacy claims submission
- Payer sheet
- Paper claim submission requirements
- Compound prescription requirements
- Prospective DUR response requirements
For questions, please contact Envolve Pharmacy Solutions 24 hours a day, seven days a week, at (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 Envolve Pharmacy Solutions 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: 1-855-266-2596 (Rx BIN: 004336).
- Payer Sheets and Pharmacy Information (PDF)
- Prior Authorization Request Form for Prescription Drugs (PDF)
- Opioid Resources for Prescribers
| PREFERRED DIABETIC SUPPLY | ITEM DESCRIPTION | QUANTITY LIMIT |
|---|---|---|
| True Metrix Air Kit | Glucose Blood Monitoring Kit (OTC) | N/A |
| True Metrix Kit | Glucose Blood Monitoring Kit (OTC) | N/A |
| True Metrix Self-Monitoring Blood Glucose Strips | Glucose Blood Test Strip (OTC) | 300 strips per 30 days |
| True Metrix Blood Glucose Test Strips | Glucose Blood Test Strip (OTC) | 300 strips per 30 days |