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Provider resources PEAR PortalLearn more

Policies and guidelines

Operations management

Medical policy

Use this online searchable database to read AmeriHealth medical and claim payment policies.

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Preapproval/precertification for services and member cost-sharing

Certain services require preapproval/precertification from AmeriHealth prior to being performed.

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Dosage and Frequency Program

Learn how AmeriHealth reviews treatment regimens for certain specialty drugs to ensure they adhere to safe prescribing limits.

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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.

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Medical necessity criteria

Our registered nurses (Care Management Coordinators) use McKesson’s InterQual criteria as their main source of decision support.

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Pharmacy information

Pharmacy policy

Use this online database to read AmeriHealth pharmacy policies.

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Drug formularies

Use our drug formularies to find the right medicine for your patients.

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Prior authorization

Download request forms and get instructions on submissions.

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Blood glucose meters

Get free blood glucose meters for your patients.

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Direct Ship Drug Program

Facilitate the shipment and precertification (as required) of medications not commonly stocked in a physician’s office.

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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.

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