For members enrolled in an AmeriHealth prescription drug program, prior
authorization and quantity limit requirements will be applied to certain drugs.
The purpose of prior authorization is to ensure that drugs are medically
necessary and are being used appropriately. Quantity limits are designed to
allow a sufficient supply of medication based upon the maximum daily dose and
length of therapy approved by the U.S. Food and Drug Administration for a
particular drug. The most recent updates are reflected below.
Drugs requiring prior authorization
The prior authorization requirement for the following non-formulary
drugs was effective at the time the drugs became available in the
marketplace:
Brand drug
Generic drug
Drug category
Effective date
Aubagio
?
Not available
Pain, Nervous System, & Psych
September 28, 2012
Qsymia
TM
Not available
Diagnostics & Miscellaneous
September 7, 2012
Stivarga
?
Not available
Cancer & Organ Transplant Drugs
September 28, 2012
The following prior authorization requirements for the following
non-formulary
drugs are effective at the time indicated below:
Brand drug
Generic drug
Drug category
Effective date
Solodyn
?
Not available
Antibiotics & Other Drugs Used for
Infection
April 1, 2013
Xyrem
?
Not available
Pain, Nervous System, & Psych
April 1, 2013
Drug with quantity limits
Quantity limits
will be added for the following drug:
Effective April 1, 2013.
Brand drug
Generic drug
Drug category
Quantity limit
(per 30 days)
Xyrem
?
Not available
Pain, Nervous System, & Psych
540ml