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Find a drug

A formulary is a list of covered medications. This list of drugs is carefully selected by the plan with the help of a team of doctors and pharmacists, and is reviewed and approved by Medicare. We may periodically add or remove covered drugs, change coverage limitations on certain drugs, or change how much you pay for a drug.

Find a prescription drug

To find covered prescription drugs, select your health plan below. You can search AmeriHealth Drug Formularies alphabetically by drug name and check for drugs recently added to or removed from the formulary.

2025 formularies for individual members

Online Search	Documents
AmeriHealth Medicare Enhanced PPO	AmeriHealth Medicare Enhanced PPO Formulary AmeriHealth Medicare Enhanced PPO Utilization Management Criteria — Prior Authorization AmeriHealth Medicare Enhanced PPO Utilization Management Criteria — Step Therapy
AmeriHealth Medicare Core PPO	AmeriHealth Medicare Core PPO Formulary AmeriHealth Medicare Core PPO Utilization Management Criteria — Prior Authorization AmeriHealth Medicare Core PPO Utilization Management Criteria — Step Therapy
AmeriHealth Medicare Secure PPO	AmeriHealth Medicare Secure PPO Formulary AmeriHealth Medicare Secure PPO Utilization Management Criteria — Prior Authorization AmeriHealth Medicare Secure PPO Utilization Management Criteria — Step Therapy
AmeriHealth Medicare Ultimate PPO	AmeriHealth Medicare Ultimate PPO Formulary AmeriHealth Medicare Ultimate PPO Utilization Management Criteria — Prior Authorization AmeriHealth Medicare Ultimate PPO Utilization Management Criteria — Step Therapy

2024 formularies for individual members

Online Search	Documents
AmeriHealth Medicare Enhanced PPO	AmeriHealth Medicare Enhanced PPO Formulary AmeriHealth Medicare Enhanced PPO Utilization Management Criteria — Prior Authorization AmeriHealth Medicare Enhanced PPO Utilization Management Criteria — Step Therapy
AmeriHealth Medicare Core PPO	AmeriHealth Medicare Core PPO Formulary AmeriHealth Medicare Core PPO Utilization Management Criteria — Prior Authorization AmeriHealth Medicare Core PPO Utilization Management Criteria — Step Therapy
AmeriHealth Medicare Secure PPO	AmeriHealth Medicare Secure PPO Formulary AmeriHealth Medicare Secure PPO Utilization Management Criteria — Prior Authorization AmeriHealth Medicare Secure PPO Utilization Management Criteria — Step Therapy
AmeriHealth Medicare Ultimate PPO	AmeriHealth Medicare Ultimate PPO Formulary AmeriHealth Medicare Ultimate PPO Utilization Management Criteria — Prior Authorization AmeriHealth Medicare Ultimate PPO Utilization Management Criteria — Step Therapy

You can contact us for the most recent list of drugs.

See Coverage Determination for Part D Drugs, Part D Appeals, and Part D Grievances to learn how to obtain an exception to the plan's formulary. This is not a complete list of all formulary alternatives covered by the Part D sponsor for the drug you have selected.

For Utilization Management information please visit our Quality Assurance page. For Tiered Cost-Sharing information please visit our Prior Authorization page.

The AmeriHealth pharmacy network

AmeriHealth contracts with an independent pharmacy benefits management (PBM) company to provide Medicare Part D prescription benefit management services.

The network includes:

national chain and independent retail pharmacies
long-term care and home-infusion pharmacies
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Program pharmacies
a network mail order pharmacy service

In order to receive benefits through the plan, prescriptions generally must be filled at a network pharmacy.

Standard and Preferred pharmacies

Some pharmacies contract with our plan to offer lower cost-sharing to plan members. This is known as preferred pharmacy cost-sharing. You may fill your prescriptions at either a preferred or standard pharmacy. You can save money on certain prescriptions by using a preferred pharmacy:

Tier 1 and 2 prescriptions (which include most generic drugs) will have lower copayments when you have them filled at preferred pharmacies.
Tier 3, 4 and 5 prescriptions (which include brand-name, specialty and high-cost generic drugs) will have the same copayments at both preferred and standard pharmacy locations.

Preferred pharmacies	Standard pharmacies
CVS Rite Aid ShopRite Stop and Shop Target Wegmans Other independent pharmacies	Acme Costco Sam's Club Walgreens Walmart Other independent pharmacies

Find a network pharmacy

To locate or confirm that a pharmacy is currently in our network:

Find a network pharmacy

If you need to use an out-of-network pharmacy in special circumstances, including illness while traveling, you may submit a Direct Member Reimbursement for review.

To request a reimbursement, please use the Direct Member Reimbursement Form. Please note that we cannot pay for any prescriptions that are filled by pharmacies outside of the United States, even for a medical emergency.

Out-of-network coverage

Covered Part D drugs are available at out-of-network pharmacies in special circumstances, including illness while traveling outside of the plan's service area where there is no network pharmacy. We may cover your prescription at an out-of-network pharmacy for up to a 30-day supply if at least one of the following applies:

If the prescriptions are related to care for a medical emergency or urgent care
If you are unable to obtain a covered drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24-hour service
If you are trying to fill a prescription drug that is not regularly stocked at an accessible network retail or mail-order pharmacy (including high-cost and unique drugs)

You may have to pay more than your normal cost-sharing amount, and will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement. We will consider your request and make a coverage decision. If we decide that the drug is covered and you followed all the rules for getting the drug, we will pay for our share of the cost.

We cannot pay for any prescriptions that are filled by pharmacies outside the United States, even for a medical emergency.

Step therapy

Certain Medicare Part B prescription drugs may be subject to Step Therapy. Step therapy is a type of coverage determination that applies to certain drugs. Step therapy requires you to first try certain drugs to treat your medical condition before the plan will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, AmeriHealth may not cover Drug B unless you try Drug A first. If Drug A does not work for you, AmeriHealth will then cover Drug B.

How to submit a paper claim

When you go to a network pharmacy, your claim is automatically submitted to us by the pharmacy. However, if you go to an out-of-network pharmacy for one of the reasons listed above, the pharmacy may not be able to submit the claim directly to us. When that happens, you will have to pay the full cost of your prescription. When you return home, simply submit a claim form and your receipt. Please note that we can only reimburse up to our allowed amount. Please call the Member Help Team for more information on paper claims.

To request a reimbursement, please use the Direct Member Reimbursement Form.

To request a reimbursement specifically for a vaccine and/or a vaccine administration fee, please use the Vaccine and Administration Direct Member Reimbursement Form. This form is for Part D vaccines only and should not be used for Part B vaccines such as the flu shot.

For the Influenza Vaccine Reimbursement Form, please see the Claim Reimbursement Forms section.

Mail-order pharmacy service

Get your prescriptions delivered right to your door by signing up for our mail-order service through OptumRx^® Home Delivery. It's an easy and convenient way to get the medications you take regularly. Through mail order, you will pay a $0 copay for Tier 1 preferred generic drugs and NEW for 2025! a $0 copay for Tier 2 generic drugs. Mail order offers you:

Free shipping. Medications can be delivered to your home, a PO Box, or a UPS or FedEx pickup location.
24/7 access. Speak to a pharmacist at any time, any day.
Language assistance. Medication bottle labels are available in Spanish, large print, and ScripTalk. Our Call Center Advocates language line solution supports over 240 languages, including TTY for the hearing-impaired.
Caregiver access. Allow a loved one to help you manage your benefits and medications.

How to use mail order

If you are filling a prescription at a retail pharmacy and would like to switch to mail order:

Log in to amerihealth.com/login to transfer a retail prescription or call 1-888-678-7015 (TTY/TDD: 711), seven days a week, 24 hours a day to find out if the prescription is eligible and ask to change to mail order.
If you call, provide your name, address, prescription number (located on your prescription bottle or package), and billing information.

If you have a new prescription:

Ask your doctor to send the prescription to be filled by OptumRx^® Home Delivery.
OptumRx^® Home Delivery will call you to confirm any details. Pharmacies must get your consent before shipping or delivering any prescription from your doctor.
Log in at amerihealth.com/login to track the status of your mail-order prescription.

To refill a mail-order prescription:

New for 2025! You have the option to sign up for an automatic refill program.

Under this program we will start to process your next refill automatically when our records show you should be close to running out of your drug.
If you choose not to use our auto-refill program, but still want the mail-order pharmacy to send you your prescription, please contact your pharmacy seven to ten days before your current prescription will run out. This will ensure your order is shipped to you in time.
To sign up for our auto refill program or request a refill, log in at amerihealth.com/login or call 1-888-678-7015 (TTY/TDD: 711), seven days a week, 24 hours a day.

You can also fill out and mail in the Prescription Mail-order Form.

Your prescriptions should arrive within 7 to 10 days after we get your complete order. Questions? Please call 1-888-678-7015 (TTY/TDD: 711), seven days a week, 24 hours a day.

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Website last updated: 8/14/2024

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