Pharmacy Prior Authorization
Opioid treatment resources
AmeriHealth Caritas Pennsylvania continues to carefully review and update our requirements for opioid prescriptions. Our collaborative goal with you is to ensure that our members are receiving the correct treatment for their pain and that opioid utilization is managed and monitored appropriately. We will continue to provide you with the most up-to-date information and resources to attain that goal.
Opioid-related prior authorization request forms:
Pharmacy prior authorizations are required for pharmaceuticals that are not in the formulary, not normally covered, or which have been indicated as requiring prior authorization.
For more information on the pharmacy prior authorization process, call the Pharmacy Services department at 1-866-610-2774.
How to submit a request for pharmacy prior authorization
Online
Save time by submitting all your pharmacy prior authorization requests online. Get started at our online prior authorization request form or learn more in our tutorial.
By phone
Call the Pharmacy Services department at 1-866-610-2774. If it’s outside of normal business hours, you can also call Member Services at 1-888-991-7200.
By fax
Please see available prior authorization request forms below.
Prior authorization criteria
Many medicines have specific requirements and conditions that must be met to receive prior authorization. Save time by viewing a list of medications and their prior authorization criteria (PDF) before submitting your request.
HCPCS medication codes requiring prior authorization
View list of HCPCS codes that require prior authorization (PDF)
View the HCPCS Authorization Form (PDF)
Drug- and Drug class-specific prior authorization request forms
To initiate a prior authorization, use one of the prior authorization request forms below.
- Antimigraine Agents, Other - CGRP Inhibitors prior authorization form (PDF)
- Antipsychotics prior authorization form (PDF)
- Botulinum Toxins prior authorization form (PDF)
- Cinqair prior authorization form (PDF)
- Cosentyx prior authorization form (PDF)
- Dupixent prior authorization form (PDF)
- Enbrel prior authorization form (PDF)
- Erythropoiesis Stimulating Agents prior authorization form (PDF)
- Fasenra prior authorization form (PDF)
- HCPCS (healthcare common procedure coding system) prior authorization form (PDF)
- Hepatitis C Agents prior authorization form (PDF)
- Humira prior authorization form (PDF)
- Intra-Articular Hyaluronates prior authorization form (PDF)
- Long-acting opioid prior authorization form (PDF)
- Makena prior authorization form (PDF)
- Nucala prior authorization form (PDF)
- Oncology Agents, Oral prior authorization form (PDF)
- Opioid dependence treatments (oral) prior authorization form (PDF)
- Remicade and Biosimilars prior authorization form (PDF)
- Short-Acting opioid prior authorization form (PDF)
- Sublocade prior authorization form (PDF)
- Synagis prior authorization form (PDF)
- Tysabri prior authorization form (PDF)
- Universal pharmacy oral prior authorization form (PDF)
- Xolair prior authorization form (PDF)
The form must be completed in its entirety and faxed to 1-888-981-5202. Failure to submit all requested information could result in denial of coverage or a delay of approval as the result of insufficient information.
General prior authorization request form
- If the drug you are requesting is not included in the options above and you wish to submit a faxed request, please use the universal pharmacy oral prior authorization form (PDF).