Pharmacy (Prescription) Benefits
The following information will give you a better understanding of the Pharmacy Benefits AmeriHealth Caritas Northeast provides.
If you cannot find what you are looking for on our website, please call Member Services at
1-855-809-9200 or take a look at our Member Handbook. 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 Northeast’s Pharmacy Services at 1-888-208-1020, or fax it to 1-855-446-7905.
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.