Rx programs available to AmeriHealth members
At AmeriHealth, we believe it is important that members have the information they need to take full advantage of programs available through the prescription drug plans we offer.
Mail order Rx program
Our mail order program saves members money by dispensing a 90-day prescription supply for less than what members would normally pay. Better yet, medications are delivered directly to the home.
To participate in the mail order program, a member who is prescribed a maintenance medication, should ask his/her doctor for two prescriptions – one for a 30-day supply to be filled immediately at a local, participating pharmacy and one for a 90-day supply (plus any necessary refills) to be filled through mail order. Enrollment forms can be obtained online at amerihealthexpress.com or by calling 1-877-214-7228.
You can read more about this program by downloading our mail order flyer.
96-Hour Temporary Supply Program
AmeriHealth also offers members a 96-Hour Temporary Supply Program to be used at participating pharmacies. Under the 96-Hour Temporary Supply Program, if a member’s doctor writes a prescription for a drug that requires prior authorization, has an age limit, or exceeds the quantity level limit for a medication and prior authorization/preapproval has not been obtained by the doctor, the following steps will occur:
1. The participating retail pharmacy will be instructed to release a 96-hour supply of the drug to the member with no out-of-pocket cost-sharing at that time.*
2. By the next business day, our Pharmacy Benefits Manager, FutureScripts, will contact the member’s doctor to request that he or she submit the necessary documentation of medical necessity or medical appropriateness for review.
3. Once the completed medical documentation is received by FutureScripts, the review will be completed, and the medication will be approved or denied.
4. If approved, the remainder of the prescription order will be filled, and the appropriate prescription drug out-of-pocket cost-sharing will be applied.
5. If denied, notification will be sent to the doctor and the member.
Please note that obtaining a 96-hour temporary supply does not guarantee that the prior authorization/preapproval request will be approved. Some medications – such as Retin-A®(tube), Enbrel® (two-week injection kit), medroxyprogesterone acetate (monthly injectable), and erectile dysfunction drugs – are not eligible for the 96-Hour Temporary Supply Program due to packaging or other limitations. Additionally, certain drugs to treat hemophilia (antihemophilic factors) are not usually purchased at the pharmacy and must be special-ordered; therefore, they are not eligible for the 96-hour temporary supply.
If you have any questions regarding our prescription drug programs, please contact your AmeriHealth broker representative.
* Members with an integrated drug benefit (e.g., CMM) will pay the discounted cost of the 96-hour supply as well as the remainder of the prescription order (if approved) at the time of purchase, and the medical claim for reimbursement will be processed through standard procedures.
