Starting January 1, 2026, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) will require all Medicare Part D exception requests – including non-formulary drugs, step therapy, tier exceptions, and quantity limits – to include pertinent clinical office notes.
This requirement is designed to ensure that each request is supported by detailed clinical information to streamline reviews and strengthen safeguards against fraud, waste, and abuse.
For more information and helpful resources, providers are encouraged to visit the Pharmacy Resource Page.
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