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, 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. We work with providers and pharmacists. 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).
- 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)
- Prior Authorization Request Form for Prescription Drugs (PDF)
|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|