Effective October 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 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 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. Prior authorization requirements help ensure that prescribed drugs are medically necessary and are being used appropriately.
• MME Limit. The MME limit is designed to help with safe and appropriate opioid use.
• Age Limit. Age limits help ensure drugs are used in the appropriate age group in furtherance of patient safety.
• 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. This also includes a day supply limit, which is based on the day supply of a prescription and not the quantity.

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 October 1, 2019. For additional information on pharmacy policies and programs, visit our websites for AmeriHealth New Jersey or AmeriHealth Pennsylvania.