Progesterone in oil, a standard
injectable medication, is currently covered for our members under their
pharmacy benefit. Effective January 1, 2012, progesterone in oil will no
longer be covered under the pharmacy benefit and will only be covered under the
medical benefit. This change is being made because this medication is not
considered a self-injectable and therefore should not be covered under the
pharmacy benefit.
Our Pharmacy Services department will
work with providers who have prescribed this injectable to a member to obtain a
new prescription and start the member in the Direct Ship Injectables Program.
This voluntary program is available for your patients who have their medical
benefits through an AmeriHealth managed care program. It facilitates the
shipment of injectable medications like progesterone in oil to your office or
the member?s home (members may continue to self-administer at your discretion).
Providers may also opt to supply the drug and bill the plan directly.
For more information about the direct
ship option, go to www.amerihealth.com/directship
. Please call Customer Service at 1-800-275-2583 if you have any questions about this
change.