Effective January 1, 2019, AmeriHealth will change the management of authorized generic drugs under our prescription drug program. Authorized generic drugs are brand-name drugs that are marketed without the brand name on the label.

How members are affected

AmeriHealth members with a prescription for an authorized generic may experience an increase in cost-sharing as of January 1, 2019. FutureScripts^?, the AmeriHealth pharmacy benefits manager, previously mailed letters to these members regarding the change. If you prescribe a therapeutic alternative of the authorized generic, the patient may see a reduced cost-share. We encourage you to discuss alternatives, if applicable, with those members.

Additionally, prior authorization is required on or after January 1, 2019, for members to have continued coverage of the affected drug. When discussing alternatives, if applicable, with those members, keeping in mind the following:

• Your patient’s current medication requires prior authorization. The prior authorization request form can be found on the FutureScripts website by selecting the appropriate formulary and then Other.
• If approved, your patient’s current medication will become subject to the highest level of cost-sharing. If you change to a therapeutic alternative of the medication, the patient may see a reduced cost-share.

Requesting a cost-share exception

Providers may request consideration for an exception once a patient has exhausted all formulary alternatives or has contraindications to using alternatives. To request consideration, complete a cost-share exception form, which is available on the FutureScripts website by selecting the appropriate formulary and then Other. 

For more information

If you have any questions concerning the prior authorization process, please contact FutureScripts at 1-888-678-7012. For more information about other recent formulary changes, refer to the Pharmacy section.