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This section includes drug formulary updates, medical policy notifications, precertification changes, and other medical- and pharmacy-related topics.

Communications


Hide details for [<div class= 'YearCat'>&nbsp&nbsp2019 Updates</div><hr style='width:749px; color:#b6b6b6;background-color: #b6
  2019 Updates

Vaccinations recommended for adult AmeriHealth membersPosted: 11/05/2019
Changes to precertification requirements for intravitreal VEGF products effective January 1, 2020Posted: 11/01/2019
View up-to-date policy activity on our Medical Policy PortalPosted: 10/24/2019
Scheduling annual well-care visitsPosted: 10/21/2019
Reminder: Coverage criteria for the annual Synagis (palivizumab) distribution program Posted: 10/17/2019
Act now! Encourage adults to get flu vaccinationsPosted: 10/10/2019
Introducing the new PEAR portal for managing clinical and financial activitiesPosted: 10/04/2019
New policy criteria for treatment of osteoarthritis of the kneePosted: 10/03/2019
Changes to precertification requirements for intravitreal VEGF products effective January 1, 2020Posted: 10/02/2019
Updated policy for Direct Access to OB/GYN servicesPosted: 10/02/2019
Updates to the list of specialty drugs that will require precertification for AmeriHealth New Jersey membersPosted: 10/02/2019
Updates to the list of specialty drugs that will require precertification for AmeriHealth Pennsylvania membersPosted: 10/02/2019
Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list for 2020Posted: 09/30/2019
Coverage update for surgical and minimally invasive treatments for urinary outlet obstruction due to BPHPosted: 09/27/2019
Expanding preventive coverage of HPV vaccinePosted: 09/27/2019
View up-to-date policy activity on our Medical Policy PortalPosted: 09/24/2019
Save the date! Pennsylvania will host Medication-Assisted Treatment Regional Summits this fallPosted: 09/19/2019
Important information! CRNP contracting and credentialingPosted: 09/17/2019
Coverage criteria for the annual Synagis (palivizumab) distribution program Posted: 09/09/2019
AIM to allow pre-service review for arterial ultrasounds Posted: 09/04/2019
Reminder: Tysabri added to the Most Cost-Effective Setting Program Posted: 09/03/2019
Clinical Appropriateness Guidelines for Radiology to be updatedPosted: 09/03/2019
Now in effect: New claim payment policy for multiple therapies Posted: 09/03/2019
Changes to the Most Cost-Effective Setting Program: Pediatric exceptionPosted: 08/27/2019
Skilled nursing, subacute, and inpatient rehabilitation facility admission guidelinesPosted: 08/23/2019
View up-to-date policy activity on our Medical Policy PortalPosted: 08/21/2019
Changes to the annual Synagis (palivizumab) distribution program Posted: 08/09/2019
New claim payment policy for multiple therapies Posted: 08/01/2019
View up-to-date policy activity on our Medical Policy PortalPosted: 07/22/2019
Updated InterQual Criteria for 2019Posted: 07/15/2019
Claim reprocessing for multiple procedure payment reductions on certain diagnostic services for AmeriHealth New Jersey membersPosted: 07/03/2019
Specialty drugs that require precertification for AmeriHealth Pennsylvania members as of July 1, 2019Posted: 07/01/2019
The AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list updated as of July 1, 2019Posted: 07/01/2019
Clinical Appropriateness Guidelines for Advanced Imaging of the Heart updated as of July 1, 2019Posted: 07/01/2019
Clinical Appropriateness Guidelines for Arterial Ultrasound updated as of July 1, 2019Posted: 07/01/2019
Clinical Appropriateness Guidelines for Radiology updated as of July 1, 2019Posted: 07/01/2019
Radiation Therapy Clinical Guidelines updated as of July 1, 2019Posted: 07/01/2019
New Dosage and Frequency Program webpages now available Posted: 06/21/2019
View up-to-date policy activity on our Medical Policy Portal Posted: 06/20/2019
Updated: New drugs added to the Dosage and Frequency Program Posted: 06/05/2019
Updates to the list of specialty drugs that will require precertification for AmeriHealth Pennsylvania members Posted: 06/03/2019
Tysabri added to the Most Cost-Effective Setting ProgramPosted: 05/30/2019
Preventive coverage of exercise interventions for the prevention of falls for commercial membersPosted: 05/22/2019
Measles disease outbreak and vaccine coverage for AmeriHealth commercial membersPosted: 05/20/2019
View up-to-date policy activity on our Medical Policy Portal Posted: 05/20/2019
Cost-sharing and billing requirements for preventive colonoscopy and flexible sigmoidoscopy services provided to AmeriHealth New Jersey membersPosted: 05/06/2019
Cost-sharing and billing requirements for preventive colonoscopy and flexible sigmoidoscopy services provided to AmeriHealth Pennsylvania membersPosted: 05/06/2019
Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing listPosted: 05/01/2019
Clinical Appropriateness Guidelines for Advanced Imaging of the Heart to be updatedPosted: 05/01/2019
Clinical Appropriateness Guidelines for Arterial Ultrasound to be updatedPosted: 05/01/2019
Clinical Appropriateness Guidelines for Radiology to be updatedPosted: 05/01/2019
Updated Radiation Therapy Clinical GuidelinesPosted: 04/22/2019
View up-to-date policy activity on our Medical Policy Portal Posted: 04/22/2019
FDA releases statement on the efficacy of LartruvoPosted: 04/12/2019
Self-funded groups must elect to participate in vendor-based utilization management programsPosted: 04/08/2019
Mumps disease outbreak and vaccine coverage for AmeriHealth members Posted: 04/05/2019
Updates to Direct Ship Drug Program listPosted: 04/04/2019
Reminder: Updated reimbursement policy for CRNPs and PAs Posted: 04/03/2019
Claim reprocessing for multiple procedure payment reductions on certain diagnostic services for AmeriHealth Pennsylvania membersPosted: 03/28/2019
View up-to-date policy activity on our Medical Policy Portal Posted: 03/25/2019
Preventive coverage of spinal muscular atrophy screening for AmeriHealth Pennsylvania membersPosted: 03/18/2019
Suspected meningococcal disease outbreak and vaccine coverage for AmeriHealth New Jersey membersPosted: 03/15/2019
Updated reimbursement policy for CRNPs and PAs Posted: 03/01/2019
View up-to-date policy activity on our Medical Policy Portal Posted: 02/22/2019
Updates to the list of specialty drugs that require precertification for AmeriHealth New Jersey membersPosted: 02/20/2019
New drugs to be added to the Dosage and Frequency ProgramPosted: 02/18/2019
Updates to the list of specialty drugs that require precertification for AmeriHealth Pennsylvania membersPosted: 02/15/2019
Four drugs added to Most Cost-Effective Setting Program for AmeriHealth Pennsylvania membersPosted: 01/25/2019
Four drugs added to the Dosage and Frequency ProgramPosted: 01/25/2019
Three drugs added to Most Cost-Effective Setting Program for AmeriHealth New Jersey membersPosted: 01/25/2019
Reminder: Updated credentialing requirements for CRNPs and PAsPosted: 01/24/2019
Acupuncture benefits and new network now in effectPosted: 01/22/2019
View up-to-date policy activity on our Medical Policy Portal Posted: 01/22/2019
Changes coming to application of Modifier 59 in 2019Posted: 01/11/2019
Changes to the management of CAPS drugs now in effectPosted: 01/07/2019
Frequency limit established for trigger point injections for myofascial pain syndromePosted: 01/03/2019
Updated AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list now in effectPosted: 01/03/2019
Updated list of specialty drugs that require precertification for AmeriHealth New Jersey members now in effectPosted: 01/03/2019
Updated list of specialty drugs that require precertification for AmeriHealth Pennsylvania members now in effectPosted: 01/03/2019
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  2018 Updates

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  2017 Updates

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  2016 Updates

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  2015 Updates

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  2014 Updates

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  2013 Updates

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  2012 Updates

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  2011 Updates












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