AmeriHealth New Jersey Custom Rx is a pharmacy product that offers lower-cost SEH drug options for all benefits plans in the following lines of business: PPO, POS, POS Plus, HMO, and HMO Plus. Members can save up to 27% compared to our current plans. Each plan will include an up-front deductible that is applicable to brand drugs only, regardless of formulary. Deductible does not apply to generic drugs.
Three variations of up-front deductibles are offered: $100, $150, and $250. AmeriHealth New Jersey has built these new deductible plans off of three existing drug plans:
- 50% / $125
- $7 / 50% / $125
- $10 / $40 / $60
About AmeriHealth New Jersey Custom Rx
Features of AmeriHealth New Jersey Custom Rx:
- There is an up-front deductible that is applicable to brand drugs only, regardless of formulary. Deductible does not apply to generic drugs. There is no need to preselect a pharmacy.
- More than 60,000 pharmacies nationwide participate in the FutureScripts® retail network, including the area’s largest retail chains.*
- When member cost-sharing is coinsurance, the out-of-pocket cost is based on the FutureScripts negotiated discount price at participating pharmacies, which is typically below average retail prices.
- No claims forms are needed when participating pharmacies are used.
- Online adjudication and eligibility verification is done at participating pharmacies.
- A computerized system at participating pharmacies instantly checks available drug history for possible drug interactions and other dangers.
Generic 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 counterparts. AmeriHealth has developed two informational pieces that will give you a better understanding of generic drugs.
Procedures That Support Safe Prescribing
The Pharmacy Services Department continuously monitors effectiveness and safety of drugs and drug prescribing patterns. There are several procedures to support safe prescribing patterns for our commercial prescription drug programs. Based on the Food and Drug Administration’s (FDA) guidelines and criteria endorsed by the FutureScripts Pharmacy and Therapeutics Committee, these procedures are designed to optimize the prescription drug benefit.
Download 
Procedures That Support Safe Prescribing.
Prior Authorization — Forms & Instructions
AmeriHealth requires prior authorization of certain covered drugs to ensure that the drug prescribed is medically necessary and appropriate according to the FDA guidelines. The approval criteria was developed and endorsed by the FutureScripts Pharmacy and Therapeutics Committee and is based on information from the FDA and manufacturers, medical literature, actively practicing consultant physicians, and appropriate external organizations. To obtain prior authorization, physicians must complete a prior authorization form and fax it to the Pharmacy Services Department at 1-888-671-5285.
Contact Information
For more information, complete an online information request, contact your broker, or call our Marketing Department at 1-866-681-7368.
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