CurrentArizona Complete HealthPolicy N/A

Pima & Yuma County Crisis Medication List (Crisis facility dispensing criteria)

Medications and dose/quantity limits authorized to stabilize Non‑Title XIX/XXI and Non‑SMI adults and children presenting in behavioral health crisis at specified Crisis Residential/Community Observation facilities in Pima and Yuma counties.

Policy Summary

PayerArizona Complete Health

PolicyPima & Yuma County Crisis Medication List

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionUse the listed medications with the specified dose and 7‑day quantity limits for stabilization in the named crisis facilities; one additional 7‑day supply is allowed as a bridge to outpatient care.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7 Daystandard quantity limit applied to most listed medications

Pima; Yumageographic applicability

Non‑Title XIX/XXI; Non‑SMImember populations specified

+1 7‑dayauthorized refill/bridge supply

5document length

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Coverage Criteria for Crisis Dispensing

Facility crisis dispensing criteria

Covered when used for stabilization in crisis for the specified population at listed facilities and provided within listed dose and quantity limits.

Eligibility and setting: Use is limited to adults or children who are Non‑Title XIX/XXI and Non‑SMI presenting in crisis at the CRC Level 1 Subacute Behavioral Health Facility in Pima County or the HHW Community Observation Unit in Yuma County.

Purpose of use: Medication is used to stabilize an individual in behavioral health crisis and to bridge them to a follow‑up outpatient appointment.

Quantity limits: Most listed medications are limited to a 7 Day Supply. One additional 7 Day supply of prescribed medication will be allowed as a bridge to outpatient care.7 Day Supply

Site restriction: Medications must be dispensed for use at the CRC Level 1 Subacute Behavioral Health Facility (Pima County) or the HHW Community Observation Unit (Yuma County).

Drug-specific examples (illustrative, not exhaustive): Examples from the authorized list include atomoxetine (capsules 10–100 mg) with a 7 Day Supply limit; clonidine and guanfacine formulations with a 7 Day Supply limit; and other listed antidepressant, antipsychotic, anxiolytic, mood-stabilizer, and substance‑use treatment agents each generally limited to a 7 Day Supply unless otherwise specified (e.g., long‑acting injectable haloperidol decanoate limited to 1 injection).7 Day Supply; 1 injection for specified LAI

This medication list applies only to adults or children who are Non‑Title XIX/XXI and Non‑SMI presenting in crisis at the named facilities: the CRC Level 1 Subacute Behavioral Health Facility in Pima County or the HHW Community Observation Unit in Yuma County. Use of these medications outside of that population or setting is not covered by this facility crisis dispensing list.

Provider Actions, Documentation & Prior Authorization

Prior Authorization

Prior authorization not specified

No prior authorization requirements are specified in this document; the list provides medications with dose and 7‑day quantity limits for crisis facility dispensing.

Step Therapy

Step therapy not specified

The policy does not describe any step therapy requirements for listed medications.

Documentation Required

Documentation note — facility medication list

The document does not provide explicit documentation or prior authorization instructions; it functions as an authorized medication list with dose and quantity limits for facility use and notes that one additional 7‑day supply is allowed.

Authorized Sites of Care

Note

Site-of-care restriction — designated crisis facilities

Medications are designated for use at the CRC Level 1 Subacute Behavioral Health Facility in Pima County or the HHW Community Observation Unit in Yuma County.

Intended site(s) of care are the two named crisis/respite facilities only.

Definitions and Target Population

Target population

PopulationAdults or children who are Non‑Title XIX/XXI and Non‑SMI presenting in crisis at the CRC Level 1 Subacute Behavioral Health Facility (Pima County) or the HHW Community Observation Unit (Yuma County).

SettingCRC Level 1 Subacute Behavioral Health Facility (Pima County) OR HHW Community Observation Unit (Yuma County).

PurposeUse for stabilization in behavioral health crisis and to bridge to a follow‑up outpatient appointment.

Quantity policy noteMedication quantity limits apply; one additional 7‑day supply of prescribed medication is allowed as a bridge to outpatient care.

Medication Quantity Limits (per dispensing event)

atomoxetine hcl cap (10,18,25,40,60,80,100 mg) — 7 Day Supply

Drugatomoxetine hcl capsule (10, 18, 25, 40, 60, 80, 100 mg)

Quantity limit7 Day Supply

Use caseFacility dispensing for crisis stabilization at listed CRC/observation units only (Non‑Title XIX/XXI and Non‑SMI).

aripiprazole tabs (2,5,10,15,20,30 mg) — 7 Day Supply

Drugaripiprazole tablets (2, 5, 10, 15, 20, 30 mg)

Quantity limit7 Day Supply

Use case

Background and Purpose

The list includes medications that have been identified as offering clinical safety and efficacy to stabilize individuals in behavioral health crisis and to serve as a bridge to outpatient follow‑up. It is intended for short‑term use in the crisis/respite facility setting, with medication quantity limits specified and one additional 7 day supply allowed to facilitate transition to follow‑up care.