The Deductible/Copayment Drug Program is a comprehensive prescription drug program. Member cost-sharing is based on an up-front deductible combined with copayments. The Deductible/Copayment Drug Program is available as either two-tier or three-tier copayment options.
Deductible/Two-Tier Copayment
Member cost-sharing for the Deductible/Two-Tier Copayment options is a two-tier copayment structure of generic/brand. The Deductible/Two-Tier Copayment options utilize the same open formulary as the Standard Drug Program.
Deductible/Three-Tier Copayment
Member cost-sharing for the Deductible/Three-Tier Copayment options is a three-tier copayment structure of generic-formulary/brand formulary/non-formulary brand.
The Deductible/Three-Tier Copayment options utilize the Select Drug Program® formulary, which is a list of medications, both generic and brand. These medications are FDA-approved and have been chosen for their reported medical effectiveness and value. The formulary is designed to include all therapeutic categories and provide physicians with prescribing options. In addition, the formulary is reviewed periodically to add new drugs and to remove brand-name drugs when a generic equivalent becomes available.
About the Deductible/Copayment Drug Program
Features of the Deductible/Copayment Drug Program:
- 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.*
- Member out-of-pocket costs for the deductible are 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 1-888-671-5280 to be reviewed.
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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