Single State Programs | Multi-State Pharmaceutical Purchasing Pool - Prime Therapeutics
Get support for single state programs
Helping states manage prescription drug costs
Forms
Arizona Health Care Cost Containment System (AHCCCS) is Arizona’s Medicaid agency that offers health care programs to serve Arizona residents. Individuals must meet certain income and other requirements to obtain services.
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Representatives of pharmaceutical companies, pharmacy benefit managers or a related entity must submit testimony in accordance with the AHCCCS Pharmacy & Therapeutics Committee Operational Policy. All testimony by representatives of pharmaceutical companies, pharmacy benefit managers and related entities must be submitted via a Public Testimony Registration Form.
Manufacturer letter
Letter (for January 2025 meeting)
Offer Form
- The Offer form provides the mechanism for you to submit your proposals for the Supplemental Rebate program.
Line Extension form
- The Arizona Line Extension form provides the mechanism for your company to submit line extensions for the Supplemental Rebate program.
P&T Meeting Public Testimony Request form
- For persons who are not representing a pharmaceutical company, pharmacy benefit manager or related entity, P&T Meeting Public Testimony may be given orally or submitted as a written document in accordance with the AHCCCS Pharmacy & Therapeutics Committee Operational Policy
- For nonpharmaceutical representatives and related entities, each person must fill out the Public Testimony Registration Form to register and must also fill out the Conflict of Interest form. All registrations and testimony must be received 15 business days prior to the AHCCCS P&T Meeting.
- For pharmaceutical representatives and related entities, please refer to the AHCCCS Contractors Operational Policy Manual Chapter 111 - P&T Operational Policy.
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Classes and Products (January 2025)
Request for offers
Email sent on Nov. 15, 2024
PDL Drug Class Review announcement
Announcement (for January 2025)
Offer form
- The Offer form provides the mechanism for you to submit your proposals for the Supplemental Rebate program.
Line Extension Form
- The Colorado Line Extension form provides the mechanism for your company to submit line extensions for the Supplemental Rebate program.
Useful links
Upcoming products and classes (December 2024)
Mass Review List (December 2024)
Participation in the Supplemental Rebate process for Florida Medicaid request for bid
Email sent on September 13, 2024
Mass review email sent on September 13, 2024
Offer form
- The Offer form provides the mechanism for you to submit your proposals for the Supplemental Rebate program.
Line Extension form
- The Florida Line Extension form provides the mechanism for your company to submit line extensions for the Supplemental Rebate program.
View the current:
Useful links
Classes and Products (November 2024)
Request for Offers
Email sent on July 19, 2024
Offer form
- The Offer form GNUP provides the mechanism for you to submit your proposals for the Supplemental Rebate program.
Line Extension form
- The Georgia Line Extension form provides the mechanism for your company to submit line extensions for the Supplemental Rebate program.