Pharmacy
Arkansas Total Care provides appropriate, 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 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, 7 days a week, at (800) 460-8988.
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. Arkansas Total Care works with providers and pharmacists to ensure that prescription medications are covered under the pharmacy benefit. 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).
- RXBIN: 004336NCPDP Version D.0 Payer Sheet - Medicaid Primary and Secondary Payer Billing OPAP (PDF)
- NCPDP Version D.0 Payer Sheet - Commercial Other Payer Amount Paid Billing (PDF)