Policies and guidelines
Use this online searchable database to read AmeriHealth medical and claim payment policies.
Clinical practice guidelines summary
Download guidelines outlining clinical practices.
Preapproval/precertification for services and member cost-sharing
Certain services require preapproval/precertification from AmeriHealth prior to being performed.
Dosage and Frequency Program
Learn how AmeriHealth reviews treatment regimens for certain specialty drugs to ensure they adhere to safe prescribing limits.
Most Cost-Effective Setting Program
Find out about this program through which AmeriHealth reviews the requested treatment settings for certain specialty drugs that are eligible for coverage under the medical benefit.
Medical necessity criteria
Our registered nurses (Care Management Coordinators) use McKesson’s InterQual criteria as their main source of decision support.
Use this online database to read AmeriHealth pharmacy policies.
Use our drug formularies to find the right medicine for your patients.
Download request forms and get instructions on submissions.
Blood glucose meters
Get free blood glucose meters for your patients.
Direct Ship Drug Program
Facilitate the shipment and precertification (as required) of medications not commonly stocked in a physician’s office.
Specialty medical drugs
Understand what constitutes a specialty medical benefit drug and view a complete list of those covered under the member’s medical benefit.