Most Cost-Effective Setting ProgramAmeriHealth wants our members to receive treatment in accordance with the coverage criteria in our medical policies and in settings that are both safe and cost-effective. Through the Most Cost-Effective Setting Program, AmeriHealth reviews the requested treatment settings for certain specialty drugs that are eligible for coverage under the medical benefit. This review is conducted as part of the precertification process for members enrolled in AmeriHealth medical plans. View the complete list of drugs in the Most Cost-Effective Setting Program. Cost-Effective SettingsFor the drugs in this program, AmeriHealth considers the following settings to be safe and cost-effective:
Hospital Outpatient Facility RequestRequests to receive treatment in the hospital outpatient facility with any of the drugs in the Most Cost-Effective Setting Program will only be considered for members who meet one of the following criteria:
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