Benefits and Services
Welcome Magellan Complete Care of Arizona members!
Magellan Complete Care of Arizona (MCC of AZ) offers a full line of physical and behavioral health services for your body and your mind. With your Arizona Medicaid benefits, you get services like:
- Primary care provider (PCP) and specialist visits
- Hospital services
- Emergency care
- Pregnancy care
- Behavioral health services
- And more!
You can find a full list of benefits and services in your MCC of AZ member handbook.
Getting care from your PCP
Your primary care provider, or PCP, is your doctor who will give you the healthcare services you need. They are the “gatekeeper” for your health. This means they play an important role in setting up most of your healthcare needs. Your PCP will help make sure all of your healthcare is coordinated between all of your providers. It’s important that you see your PCP at least once a year for regular checkups. It’s especially important to make an appointment to see them when you’re feeling sick.
It’s important to let them know if there’s been any changes to your health. Your PCP understands your healthcare needs and can refer you to a specialist if you need one.
MCC of AZ works with many types of doctors and providers. As an MCC of AZ member, you should choose a network provider for all your care. Use our Find a Provider or Pharmacy tool to search for an MCC of AZ provider near you.
Pharmacy and prescription benefits
Magellan Complete Care of Arizona (MCC of AZ) members get prescription drugs and other pharmacy benefits from the plan with no copays or deductibles. Your drugs are covered when you show your member ID card at a network pharmacy whenever you get your prescriptions filled.
We use MagellanRx to administer your pharmacy benefits. Visit the MagellanRx website to:
- Order refills for existing and unexpired mail-order prescriptions
- Learn about potential drug-to-drug interactions
- Understand your drugs common side effects or significant risks
- Find out the availability of generic substitutions
- Find the location of an in-network pharmacy based on a proximity search by ZIP code
- Find out if a medicine has been recalled
You may qualify to have your regular medicine mailed to you. To get started:
- Call Member Services at 1-800-424-5891 (TTY 711)
- Talk with the representative and check if your medicine qualifies for this service
- Complete the request and your medicine will be mailed to you
You may also talk to you doctor if you have more questions about mail order services.
What drugs does MCC of AZ cover?
MCC of AZ covers a comprehensive list of drugs chosen for their effectiveness by MCC of AZ along with a team of doctors and pharmacists. This drug list, called a formulary, lists brand name and prescription drugs and lists any rules or restrictions that apply. We also cover many over-the-counter (OTC) medications when you have a prescription from your doctor. Visit the MCC of AZ Searchable Drug List to review the formulary.
How much do I pay for my prescriptions?
MCC of AZ members have no annual deductible and no premiums.
Where can I get my prescriptions filled?
Use the provider search tool to search for a network pharmacy near you. Our network includes many types of pharmacies and drugstores, including mail-order and specialty pharmacies.
How do I use the formulary?
There are two (2) ways to find your drug in the formulary:
- Search by medical condition:
Drugs are grouped by the medical conditions they are used to treat. If you know what the drug is used for, look for the category name, then the drug name. For example, drugs used to treat a heart condition are listed under the category Cardiovascular Medications.
- Search by drug name:
Use the index at the back of the book to search by drug name. Drugs in the Index are listed alphabetically. Then, go to the page number listed beside the drug name to get information about the drug.
When you find your drug, any rules or special requirements are listed under the column titled Requirements/Limits. There are generally three (3) types of requirements your drug may have:
- Prior Authorization: indicated by PA in the Requirements/Limits column
- Quantity Limits: indicated by QL in the Requirements/Limits column
- Step Therapy: indicated by ST in the Requirements/Limits column
What is prior authorization?
For certain drugs, you or your provider need to get preapproval (or prior authorization) from MCC of AZ before you fill your prescriptions. If you don’t get approval, we may not cover the drug.
Learn how to request prior authorization from MCC of AZ.
Download the prior authorization form based on the type of prescription you need:
- Prior authorization request form
- Prescription drug prior authorization request form
- Specialty medication prior authorization request form
What are quantity limits?
MCC of AZ limits the amount of certain medication you can receive within a certain time period. We do this to help ensure safe, cost-effective use of these drugs. For example, if it’s considered safe to take only one pill per day of a drug, we may limit the quantity you’re able to receive to 30 pills in a 30-day period.
What is step therapy?
In some cases, we require that you first try certain drugs to treat your medical condition before we will cover another drug for that same condition. For example, if Drug A and Drug B both treat the condition but Drug A costs less, you may need to try Drug A first. If Drug A doesn’t work for you, we’ll then cover Drug B. Your provider can learn more about how we determine whether step therapy is needed here.
What if I need a drug that’s not on the formulary?
There may be times when you need a drug that’s not on our formulary or that is on our formulary but has restrictions. When this happens, you can:
- Talk to your doctor to decide if you should switch to another drug on our formulary.
- Your doctor can then call MCC of AZ to request a formulary exception.
- You may be able to get a temporary supply of the drug.
Temporary (or transition) supply
In certain situations, we can provide a temporary supply of your drug. This applies to:
- New MCC of AZ members within the first 90 days of membership
- Current members affected by annual formulary change during the first 90 days of the new year
- You may request a formulary exception in advance for the following year
During the transition period, we will automatically process a 30-day supply refill of your drug. Quantity may be less if your prescription is written for less than a 30-day supply. Once we cover the temporary supply, we generally won’t cover the drug again under our transition policy. You’ll receive a written notice explaining the steps you can take to request an exception or to work with your doctor on finding another drug on our formulary.
For new members residing in long-term care facilities, we’ll cover more than one refill during the first 90 days of membership. If you’ve been enrolled for more than 90 days, we’ll cover a temporary 31-day emergency supply (unless the prescription is for fewer days) while you’re pursuing the formulary exception.
Getting a ride to your covered services
With your MCC of AZ benefits, you can get a ride to any covered service at no cost. Please call our Member Services team and we’ll connect you with someone who will help you set up a ride to your covered service. Please call at least 72 hours before your scheduled visit.
Behavioral health resources in schools
MCC of AZ understands the importance of mental health, especially for school-aged children. MCC of AZ works collaboratively with both school districts and community behavioral health providers to ensure school districts have the resources they need to meet the needs of their students.
MCC of AZ works closely with providers who offer services on school campuses as well as who providers who are direct referral source when a specific need is identified.
If you need help or if you have any questions, please call the children’s healthcare administrator at 480-662-9395. MCC of AZ works to make sure each member gets the services they need in order to improve their health.