Save your patients money with the formulary
Members who have prescription drug coverage administered by AmeriHealth are covered under one of several formulary-based prescription drug benefit programs. These programs are designed to provide physicians with a range of prescribing options while maintaining cost-effectiveness for AmeriHealth members.
Note: Some members may have prescription drug coverage under the Standard Drug Program Formulary. Those members should review formulary information by logging on to amerihealth.com/login, our secure member website.
Effective use of the formulary
Help your AmeriHealth patients make the most of their health care dollars. Before prescribing a medication to an AmeriHealth member, please consider whether the drug is included in the formulary used in their prescription drug benefit program.
When you prescribe a formulary medication, AmeriHealth members are able to receive the drug for a lower copayment. If you prescribe a drug not on the formulary, the member’s out-of-pocket cost will be greater.
The use of the formulary doesn’t prohibit you from prescribing a covered medication. You’re able to prescribe any covered medication, regardless of whether the drug is on the formulary or not.
Before prescribing a medication to an AmeriHealth member, you should work with that member to determine if the drug is included on the formulary. If a member is currently taking a drug that does not appear on the formulary, you may be able to change the prescription to a similar drug that is on the formulary.
The Value 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 drugs when a generic equivalent becomes available. When a generic equivalent becomes available, the brand drug may be subject to a change in cost share. Drugs not found on the formulary are only covered when a medical necessity request is approved.
When you prescribe a formulary medication, AmeriHealth members receive the drug for a lower out-of-pocket cost share. If you prescribe a drug not on the formulary (non-formulary), you must submit a medical necessity request. Instructions can be found on the prior authorization page.
- Search the Value formulary
- Download our Value formulary
- See the latest Value Formulary changes for New Jersey (effective 7/1/2023)
- See the latest Value Formulary changes for Pennsylvania (effective 7/1/2023)
The Select formulary includes all generic drugs and a defined list of brand drugs that have been chosen for their reported medical effectiveness, positive results and value.
The Select 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 drugs when a generic equivalent becomes available.
- Search the Select formulary for New Jersey
- Download the Select formulary for New Jersey
- See the latest Select Formulary changes for New Jersey (effective 7/1/2023)
- Search the Select formulary for Pennsylvania
- Download the Select formulary for Pennsylvania
- See the latest Select Formulary changes for Pennsylvania (effective 7/1/2023)
Standard Prescription Drug Program
The Standard Prescription Drug Program provides comprehensive prescription drug coverage. The member cost-sharing for this program is either a two-tier copayment structure of generic/brand or coinsurance.
List of preferred drugs
The list of preferred drugs is a comprehensive listing of preferred medications available to members who do not participate in the Value or Select formularies.
The list of preferred drugs helps members receive quality, affordable medications.
The list of preferred drugs has been organized into therapeutic classes and includes the generic and brand names of the drug. We encourage physicians to use the list to help members receive the lowest out-of-pocket expense. Medications on this list may be subject to the member’s contract exclusions and other pharmacy edits.
The list of preferred drugs can also be obtained by calling our Provider Supply Line at 1-800-858-4728.
AmeriHealth offers two preferred options for participating providers to request fulfillment of specialty pharmacy drugs for patients with an AmeriHealth prescription drug benefit: Optum® and PerformSpecialty®. Optum and PerformSpecialty supply specialty drugs eligible under the AmeriHealth member’s prescription drug benefit, which is administered by an independent pharmacy benefits management (PBM) company.
Providers who are considering beginning an AmeriHealth member on a new specialty drug therapy covered under the pharmacy benefit can use the following information:
- Optum. Providers can call Optum® Specialty Pharmacy and Optum® Infusion Pharmacy at 1-855-427-4682 to enroll the member. Members can reach Optum to have a prescription filled by calling 1-855-427-4682 or by visiting the Optum website.
- PerformSpecialty. Providers can call the PerformSpecialty patient care line at 1-855-287-7888 to enroll the member. Members can reach PerformSpecialty to have a prescription filled by calling their patient care line at 1-855-287-7888 or by visiting the PerformSpecialty website.
Prescription Drug Guidelines
Learn how prescription drug benefit programs use safe prescribing procedures to give members access to the drugs they need while keeping them safe.