Effective January 1, 2019, AmeriHealth will make changes to its Select Drug Program^? Formulary and Value Formulary.

• Select Drug Program Formulary. This formulary-based prescription drug benefit program is available to all commercial members. It includes all generic drugs and a defined list of brand-name drugs. All of the drugs on the formulary have been approved by the U.S. Food and Drug Administration (FDA) and were chosen for formulary coverage based on their medical effectiveness, safety, and value. The AmeriHealth Pharmacy and Therapeutics Committee reviews the formulary periodically to ensure its continued effectiveness. The Select Drug Program Formulary is available to both AmeriHealth New Jersey and AmeriHealth Pennsylvania members.
• Value Formulary. This is a restricted formulary managed by AmeriHealth and is available to AmeriHealth Pennsylvania commercial members. The selection of drugs for inclusion in the Value Formulary is similar to the Select Drug Program Formulary. All of the drugs on the formulary have been approved by the FDA and were chosen for formulary coverage based on their medical effectiveness, safety, and value. Drugs not included on the formulary (non-formulary drugs) have covered equivalents and/or alternatives used to treat the same condition.

In addition, new and updated prior authorization, morphine milligram equivalent (MME) limit, age limit, and quantity limit requirements will be applied to certain drugs on the formularies.

• Prior Authorization. The purpose of prior authorization is to ensure that drugs are medically necessary and are being used appropriately.
• MME Limit. The MME limit is designed to ensure safe and appropriate opioid use.
• Age Limit. An age limit edit was put in place to ensure drugs are used in the appropriate age group to prevent potential harm to members.
• Quantity Limit. Quantity limits are designed to allow a sufficient supply of medication based upon the maximum daily dose and length of therapy approved by the FDA for that drug.

Please review the Select Drug Program Formulary changes for AmeriHealth New Jersey and AmeriHealth Pennsylvania and the Value Formulary changes for AmeriHealth Pennsylvania that go into effect January 1, 2019. For additional information on pharmacy policies and programs, visit our websites for AmeriHealth New Jersey or AmeriHealth Pennsylvania.