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AmeriHealth 65® Plus

Drug Formulary

Important member announcements

July 13, 2007 — We learned that all Part D members with FutureScripts Secure as their pharmacy benefits manager were incorrectly being charged a higher copay for all generic drugs. This error occurred only on July 12 lasting until 5:30 EST. Please be assured we corrected the problem. If your pharmacy called FutureScripts Secure to question the copay, FutureScripts Secure resolved the issue and the pharmacy charged you the correct copay. If your pharmacy did not call FutureScripts Secure and you were charged an incorrect copayment, you will be notified regarding reimbursement. If you have any questions, please contact Member Services between the hours of 8 a.m. and 8 p.m. seven days a week at the number on the back if your ID card.

Because of a technical error, the Medicare Formulary Finder site (www.medicare.gov) states that Avalide (combination dosage strength of 12.5mg/150mg) requires prior authorization. Please note that this is incorrect. Rest assured that members who submit a prescription for this dosage of Avalide at either a retail or mail-order pharmacy will not require prior authorization. We apologize for any confusion this may have caused.

If you received a 2007 Product Information packet or Annual Notice of Change with our list of formulary drugs in the mail this fall, we want to let you know that due to a technical problem, there were differences in the copay costs for certain drugs listed compared to what you may have found on the Medicare website. Read more.

 

A formulary is a list of carefully selected FDA-approved drugs that have been chosen by the AmeriHealth Pharmacy & Therapeutics Committee for their medical effectiveness and value. The Drug Formulary was developed to address the continually growing cost of prescription medications. Formulary contents are subject to change within a contract year without notice.

For AmeriHealth 65 Plus, call at 1-800-898-3492 (TTY/TDD 1-877-219-5457) 8:00 am to 8:00 pm seven days a week.

For AmeriHealth Rx, call 1-866-456-1690 (TTY/TDD 1-866-456-1683) 8:00 am to 8:00 pm seven days a week.

If you enroll in a drug program that uses the Drug Formulary it would benefit you to discuss your medications with your doctor. If you are prescribed a drug that is not on the formulary, your doctor may be able to change your prescription to a similar drug that is.

By selecting a drug listed on the formulary, you will pay a lower copayment. This program does not prohibit you from receiving a covered prescription medication even if it is not on the list. The difference is the amount of out-of-pocket expense you will have to pay.

Learn about our Drug Formulary

Search our Drug Formulary by:

Instructions for using the Formulary Search Tools

You can search for your drug under its drug class or by an alphabetical index. The formulary agent is listed by a green checkmark. A "G" indicator means that the drug is available as a generic and you will be responsible for your generic, Tier one copay. If there is no "G" and a green checkmark, the drug is available as a brand-name drug, and you will be responsible for your preferred brand, Tier two copay. If your drug is not listed or there is a "NP (non-preferred)" indicator, you will be responsible for your non-preferred, Tier 3 copayment.

If your search results indicate that a drug is not covered, see Exceptions & Appeals to obtain an explanation of how to obtain an exception to the Part D Plan's formulary.

Generic and Brand-Name Drugs
As the cost of prescription drugs continues to rise, it is important to understand the value of generic drugs, a safe and effective alternative to their brand-name counterparts.

Exceptions & Appeals
Information on Appeals, Grievances, and Prior Authorization.

Prior Authorization Submission
AmeriHealth requires prior authorization of certain covered drugs that have been approved by the Food and Drug Administration (FDA) for specific medical conditions.

Transition Process
To help ensure smooth transitions to drugs that are covered by the plan.

Formulary Questions & Answers
A listing of frequently asked questions regarding the drug formulary and answers to those questions.

Formulary Changes
AmeriHealth regularly reviews the formulary to ensure its continued effectiveness. View the current list of additions, deletions, and drugs with prior authorization.

Formulary Documents
The formulary documents are now available as PDF files on our website.

Important information about links to other sites