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• Direct Ship Injectables Program

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Prior Authorization*

Pharmacy Benefit

For members who have prescription drug coverage through AmeriHealth, prior authorization is required for coverage of certain prescribed covered drugs that have been approved by the U.S. Food and Drug Administration (FDA) for specific medical conditions. The approval criteria were developed and endorsed by the AmeriHealth Pharmacy and Therapeutics Committee and are based on information from the FDA, manufacturers, medical literature, actively practicing consultant physicians, and appropriate external organizations.

All requests will be reviewed by FutureScripts^®, our pharmacy benefits manager, on behalf of AmeriHealth.

A request form must be completed for all medications that require prior authorization. Submit by fax using the forms posted at www.futurescripts.com/for_health_care_professionals/prior_authorization, or submit electronically using the NaviNet^® web portal.

Request form instructions

Providers:

1. When completing a prior authorization form, all requested information on the form must be supplied.
2. Please fax completed forms to FutureScripts at 1-888-671-5285 for review. Make sure you include your office telephone and fax numbers.
3. You will be notified by fax if the request is approved. If the request is denied, you and your patient will receive a denial letter.
4. If you have not received a response after two business days from when you submitted your completed form, please call FutureScripts at 1-888-678-7012.

Members:

1. Take the appropriate request form to your physician to be completed.
2. You or your physician should fax the completed form to FutureScripts at 1-888-671-5285 for review.
3. If you have not received a response after two business days from when your completed form was submitted, please contact your physician who requested your prior authorization.

As with all our preauthorization requirements, the prior authorization form must be completed in full to avoid delay. If you have questions about the preauthorization process, call 1-800-275-2583.

Please refer back to the main Pharmacy page for more information about the Standard and Select Drug Program^® formularies.

Direct Ship Injectables Program — Medical Benefit

The AmeriHealth Direct Ship Injectables Program facilitates the shipment and precertification (as required) of injectable medications such as Synvisc^®, Hyalgan^®, Lupron^®, Zoladex^®, and other injectable drugs that are not commonly stocked in a physician’s office.

Items not facilitated through this program include most vaccines, antibiotics, chemotherapy, vitamin B-12 injections, and drugs administered by infusion or routinely obtained by the physician at a relatively low cost.

This voluntary program is available for all of your patients who have their medical benefits through an AmeriHealth managed care program. Please see the Direct Ship Injectables Program page for more information and for the appropriate form.

As with all our preauthorization requirements, the prior authorization form must be completed in full to avoid delay. If you have questions about the preauthorization process, please call 1-800-275-2583.

* The prior authorization list of forms is subject to change.

Note: The prior authorization criteria for Medicare Part D are available on www.amerihealthmedicare.com/find_a_drug.

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