Abarca performs Pharmacy Program Administration (PPA) services for the PR Government Health Insurance Plan (PRGHIP), which is administered by the PR Health Insurance Administration (ASES) with federal Medicaid and state funds. The PRGHIP covers approximately 1.4 million lives. As PPA for ASES, Abarca is responsible for providing the following services: rebate program management services for branded drug products; development and maintenance of the Maximum Allowable Cost (MAC) List for generic drug products; and development of Covered Medication Formularies (FMCs) for the program, among other services.
Abarca has served as PPA for ASES since late 2006. In its role as PPA, Abarca has worked with ASES to significantly increase drug discounts in the form of rebates and help stem inflation through its dynamic MAC pricing.
Below are important resources issued by ASES:
Medication Formularies for PRGHIP Beneficiaries and Providers
The following Covered Medication Formularies (FMCs) serve to guide specific providers on medication decisions under the most updated cost-effective coverage.
- Authorization Criteria – Abatacept IV, SC (Orencia®)
- Authorization Criteria – Abiraterone (Zytiga®)
- Authorization Criteria – Tumor Necrosis Factor Alpha (TNFα) Adalimumab (Humira®)
- Authorization Criteria – Alendronate Sodium 40mg Tablets
- Authorization Criteria – Amphetamine XR Susp (Dyanavel XR)
- Authorization Criteria – Apixiban (Eliquis)
- Authorization Criteria – Epinephrine Auto – Injector
- Authorization Criteria – Tumor Necrosis Factor Alpha (TNFα) – Etanercept (Enbrel®)
- Authorization Criteria – Natalizumab (Tysabri®) – Crohn’s Disease
- Authorization Criteria – Sunitinib (Sutent)
- 18-0104: Cambios al Formulario de Medicamentos Preferidos
- 18-0205: Cambio en cubierta de Tamiflu® suspensión presentación genérica
- 18-0315: Cambios al Formulario de Medicamentos Preferidos
- 18-0319: Política de Manejo de Medicamentos por Excepción
- 18-0521: Cambios al Formulario de Medicamentos en Cubierta (FMC)
- 18-0612: Medicamentos en el Formulario de Medicamentos en Cubierta (FMC) de ASES
- 18-0629: Cambios al Formulario de Medicamentos en Cubierta (FMC)
- 18-0724: Cambios al Formulario de Medicamentos en Cubierta (FMC)
- 18-0726: Cambios al Formulario de Medicamentos en Cubierta (FMC)
The information contained in this website is provided for informational purposes only. No warranty expressed or implied is made regarding the accuracy, adequacy, completeness, reliability or usefulness of any information contained herein. For official information, please contact the Puerto Rico Health Insurance Administration (ASES for its Spanish acronym). Neither Abarca Health, LLC or its affiliates shall be held liable for any improper or incorrect use of the information described and/or contained herein and assumes no responsibility for the use of such information.