COVID-19 (Coronavirus): AmeriHealth drug program formulary updates

April 29, 2020

AmeriHealth is committed to providing our members with access to the care they need. As COVID-19 has escalated into a pandemic, we are working to make sure that our members can receive appropriate testing and treatment for the virus causing COVID-19 if needed.

We encourage all AmeriHealth members to visit our dedicated AmeriHealth New Jersey and AmeriHealth Pennsylvania COVID-19 webpages regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

Select Drug Program® Formulary and Value Formulary updates

As of April 20, 2020, AmeriHealth made changes to its Select Drug Program Formulary and Value Formulary in response to the drug supply shortage concern due to COVID-19. These quantity limit edits are designed to preserve continued supply for chronic indications and ensure access for acute use. 

The following quantity limit edits are in now effect:

  • Albuterol and levalbuterol inhalers: These have a limit of two inhalers per 30 days. This limit applies to all brand, authorized generic, and generic products. Examples include Proair® HFA, Ventolin® HFA, and albuterol HFA.  
  • Oral Azithromycin products: These products have quantity limits outlined below that will provide adequate access for U.S. Food & Drug Administration (FDA)-approved acute use.
    • 250mg (includes Z-Pak): 6 tablets per 30 days
    • 500mg: 3 tablets per 30 days
    • 600mg: 8 tablets per 28 days  
    • 1-gram packet: 2 packets per 30 days
    • 100mg/5ml suspension: 75ml per 30 days
    • 200mg/5ml suspension: 120ml per 30 days
  • Hydroxychloroquine (Plaquenil®) and chloroquine*: These have quantity limits outlined below. The automatic bypass described below will allow chronic users (assumed FDA-approved) continued access to the drugs. A point-of-sale message will be available for the dispensing pharmacists to encourage filling the prescription for appropriate COVID-19 use.
    • Hydroxychloroquine (Plaquenil®) will be limited to 30 tablets within a 90-day time period with an automatic bypass for members who have utilized at least a 60-day supply within the past 120 days.
      • Members newly starting on hydroxychloroquine for a chronic condition will be able to request quantities beyond 30 tablets through a prior authorization.
    • Chloroquine 500mg will be limited to 30 tablets within a 90-day time period.
    • Chloroquine 250mg will be limited to 40 tablets within a 90-day time period.

Our Pharmacy Services team will continue to review and determine if there is an ongoing need for the quantity limits to remain in place.

*For the AmeriHealth Pennsylvania Premium Formulary, only hydroxychloroquine (Plaquenil®) and chloroquine quantity limits described above would apply.

Learn more

For more information about the AmeriHealth position on COVID-19, please review the following resources: