Pharmacy (prescription) benefits
The following information will give you a better understanding of the pharmacy benefits AmeriHealth Caritas provides.
If you cannot find what you are looking for on our website, please take a look at our member handbook or call Member Services at 1-888-991-7200. Our representatives are there to help you 24 hours a day, 7 days a week.
Monthly prescription limits
Some medicines may have monthly limits on the number of prescriptions or refills. This is shown in the drug formulary. To request a prescription limit prior authorization, the doctor who prescribed the medicine should contact AmeriHealth Caritas Pennsylvania’s Pharmacy Services at 1-866-610-2774, or fax it to 1-888-981-5202.
In some cases, we require you to try certain drugs first to treat your medical condition before another drug for that condition will be covered. For example, if drug A and drug B both treat your medical condition, we may not cover drug B unless you try drug A first. If drug A does not work for you, we will then cover drug B. The drug formulary shows which drugs this applies to. If your provider thinks that you need to a have certain medicine before trying another, your doctor may ask for it by submitting a prior authorization to start the next medicine in line.