For commercial 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:

Effective April 1, 2015, the following non-formulary drugs have been added to the list of drugs requiring prior authorization:

Drugs requiring prior authorization with new criteria

Effective April 1, 2015, current members taking these medications will require a new prior authorization:

Drugs with quantity limits

Effective April 1, 2015, quantity limits will be added or updated for the following drugs:

Drug no longer requiring prior authorization

Effective February 1, 2015, prior authorization has been removed for the following drug:

For additional information on pharmacy policies and programs, please visit the Pennsylvania providers Pharmacy Information page for providers in Pennsylvania or the New Jersey providers Pharmacy Information page for providers in New Jersey.