Pharmacy (Prescription) Benefits
The following information will give you a better understanding of the pharmacy benefits AmeriHealth Caritas Pennsylvania provides.
- Find a pharmacy
This tool will help you find a pharmacy that takes AmeriHealth Caritas Pennsylvania in your area.
- Pennsylvania Medical Assistance Program Preferred Drug List (PDL) (includes PDF of DHS PDL)
- AmeriHealth Caritas Pennsylvania Searchable Formulary
- AmeriHealth Caritas Pennsylvania Supplemental Formulary (PDF)
- Medicine benefits
AmeriHealth Caritas Pennsylvania covers medically needed, Food and Drug Administration (FDA)-approved medicines prescribed by your health care provider to help keep you healthy, or treat you when you are sick.
- 90-Day Supply Medication List (PDF)
Some medicines may be filled for a 90-day supply. Talk with your doctor or pharmacist if you have questions about your medicines.
If you cannot find what you are looking for on our website, please take a look at our member handbook or call Member Services at 1-888-991-7200. Our representatives are there to help you 24 hours a day, 7 days a week.
Monthly prescription limits
Some medicines may have monthly limits on the number of prescriptions or refills. This is shown in the drug formulary. To request a prescription limit prior authorization, the doctor who prescribed the medicine should contact AmeriHealth Caritas Pennsylvania’s Pharmacy Services at 1-866-610-2774, or fax it to 1-888-981-5202.
Generic substitution and step therapy
There may be times when a generic medicine is used in place of a brand-name medicine. This may happen if the generic medicine has the same therapeutic properties as the brand-name medicine. This is called generic substitution. Talk with your doctor or pharmacist if you have questions about your medicines.
In some cases, we require you to try certain drugs first to treat your medical condition before another drug for that condition will be covered. For example, if drug A and drug B both treat your medical condition, we may not cover drug B unless you try drug A first. If drug A does not work for you, we will then cover drug B.
The drug formulary shows which drugs this applies to. If your provider thinks that you need to a have certain medicine before trying another, your doctor may ask for it by submitting a prior authorization to start the next medicine in line.
Do more online. Don’t wait until you run out. Get automatic refill reminders in the member portal.