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Prior Authorization*

For members who have prescription drug coverage through AmeriHealth, prior authorization is required for certain prescribed formulary drugs in order for such drugs to be covered. The approval criteria were developed and endorsed by the Pharmacy and Therapeutics Committee and are based on information from the U.S. Food and Drug Administration, manufacturers, medical literature, actively practicing consultant physicians, and appropriate external organizations.

A request form must be completed for all medications that require prior authorization. Prior authorization requests are reviewed by FutureScripts^®, our pharmacy benefits manager, on behalf of AmeriHealth. Submit by fax using the forms posted on the FutureScripts website.

Request form instructions

Providers

• When completing a prior authorization form, all requested information on the form must be supplied.
• Please fax completed forms to FutureScripts at 1-888-671-5285 for review. Make sure you include your office telephone and fax numbers.
• 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.
• 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:

• Take the appropriate request form to your physician to be completed.
• You or your physician should fax the completed form to FutureScripts at 1-888-671-5285 for review.
• 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 to the Drug Formularies page for more information about the different formularies offered by AmeriHealth.