Prescription drug information

AmeriHealth Administrators’ prescription drug plans are administered by an independent pharmacy benefits management company. Before prescribing a medication, providers should work with the plan member to determine if the drug is included on the formulary.

Drug formularies

Members who have prescription drug coverage through AmeriHealth Administrators 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 Administrators members.

Select Formulary

• Prescription Drug Program Select Formulary (Prior Authorization Required)
• Prescription Drug Program Select Formulary

Premium Formulary

The Premium Formulary differs from the standard drug formulary in that it excludes 80 medications, which all have clinical alternatives included in the Premium Formulary. The Premium Formulary is managed and maintained by our pharmacy benefits manager.

• Premium formulary guide
• Latest formulary changes
• Premium formulary utilization management updates
• Procedures that support safe subscribing
• Premium formulary exclusion list
• Premium formulary prior authorization list
• Premium formulary step therapy list
• Premium formulary quantity limit list
• HDHP preventive drug list
• HCR preventive drug list
• HCR preventive $0 HIV PrEP

*Some specialty medications, such as infusion drugs or drugs administered by the physician in the office, may be covered by the plan member’s medical benefits plan and may require precertification.

Prior authorization is required for certain prescribed formulary drugs in order for such drugs to be covered. A request form must be completed for all medications that require prior authorization.

Submitting a prior authorization request

To simplify your experience with prior authorization and save time, please submit your prior authorization request to the pharmacy benefits manager through any of the following online portals:

• CoverMyMeds^®
• Surescripts^®

Prior authorization via fax

If you prefer, you can also submit prior authorization requests by fax using the forms listed below:

Commercial prior authorization forms

Select formulary

• General fax form
• Acute migraine agents
• CNS stimulants — high cumulative dose
• Immune modulating therapy
• Opioid management — Buprenorphine/naloxone (Bunavail^®/Suboxone^®/Zubsolv^®) and Buprenorphine (Subutex^®)
• Opioid Management — Morphine Milligram Equivalent (MME) > 90 mg/day, Long-acting opioids, Short-acting opioids for short term Use, and Quantity
• Opioid Management — Short-acting opioids for continuation beyond 30 days
• Cost-share exception policy for preventative medications and women’s preventive services
• Select formulary exception prior authorization request form

Premium formulary

• Dispense as written (DAW) override request form
• General fax form
• Health care reform copay waiver request form

Pharmacy Benefits Manager

Call 1-888-678-7013
1-888-671-5285 (fax)