Effective July 1, 2018, changes will be made to the AmeriHealth Select Drug Program^® Formulary and Value Formulary.

• Select Drug Program Formulary. This formulary-based prescription drug benefit program available to all commercial members. It includes all generic drugs and a defined list of brand-name drugs that have been approved by the U.S. Food and Drug Administration (FDA), 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.
• 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. Drugs are included based on 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, effective July 1, 2018, new and updated prior authorization and quantity limit requirements will be applied to certain drugs for commercial members enrolled in an AmeriHealth prescription drug program. 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 FDA for a 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 July 1, 2018. For additional information on pharmacy policies and programs, visit our websites for AmeriHealth New Jersey or AmeriHealth Pennsylvania.