AmeriHealth drug program formulary updates

September 1, 2020

Effective October 1, 2020, AmeriHealth will make changes to its Select Drug Program® Formulary and Value Formulary.

  • Select Drug Program Formulary. This formulary-based prescription drug benefit program is available to all commercial members. It includes all generic drugs and a defined list of brand-name drugs. All drugs on the formulary have been approved by the U.S. Food & Drug Administration (FDA) and were chosen for formulary coverage based on their medical effectiveness, safety, and value. The AmeriHealth Pharmacy and Therapeutics Committee reviews the formulary periodically to ensure its continued effectiveness.
  • Value Formulary. This is a restricted formulary managed by AmeriHealth and is available to commercial members. The selection of drugs for inclusion in the Value Formulary is similar to the Select Drug Program Formulary. All drugs on the formulary have been approved by the FDA and were chosen for formulary coverage based on their medical effectiveness, safety, and value. Drugs not included on the formulary (non-formulary drugs) have covered equivalents and/or alternatives used to treat the same condition.

In addition, the following prior authorization, morphine milligram equivalent (MME) limit, age limit, and quantity limit requirements will be applied to certain drugs on the formularies.

  • Prior Authorization. Prior authorization requirements help ensure that prescribed drugs are medically necessary and are being used appropriately.
  • MME Limit. The MME limit is designed to help with safe and appropriate opioid use.
  • Age Limit. Age limits help ensure drugs are used in the appropriate age group in furtherance of patient safety.
  • Quantity Limit. Quantity limits are designed to allow a sufficient supply of medication based upon the maximum daily dose and length of therapy approved by the FDA for that drug. This also includes a day supply limit, which is based on the day supply of a prescription and not the quantity.

Please  review the Select Drug Program Formulary changes for AmeriHealth New Jersey and AmeriHealth Pennsylvania and the Value Formulary changes for AmeriHealth New Jersey and AmeriHealth Pennsylvania that go into effect October 1, 2020.

To view Select Drug Formulary information for your patients who carry an AmeriHealth Administrators ID card, visit the AmeriHealth Administrators website.

For additional information on pharmacy policies and programs, visit our websites for AmeriHealth New Jersey or AmeriHealth Pennsylvania.