Drug formularies
Save your patients money with the formulary
When you prescribe a formulary medication, AmeriHealth New Jersey members are able to receive the drug for a lower copayment. If you prescribe a drug not on the formulary, the member’s out-of-pocket cost will be greater.
The use of the formulary doesn’t prohibit you from prescribing a covered medication. You’re able to prescribe any covered medication, regardless of whether the drug is on the formulary or not.
Before prescribing a medication to an AmeriHealth New Jersey member, you should work with that member to determine if the drug is included on the formulary. If a member is currently taking a drug that does not appear on the formulary, you may be able to change the prescription to a similar drug that is on the formulary.
Value formulary
The Value formulary includes generic drugs and a defined list of brand-name drugs that have been chosen for formulary coverage based on their reported medical effectiveness, positive results, and value.
The Value formulary is designed to include all therapeutic categories and provide physicians with prescribing options. In addition, the formulary is reviewed periodically to add new drugs and to remove brand drugs when a generic equivalent becomes available. When a generic equivalent becomes available, the brand drug may be subject to a change in cost share. Drugs not found on the formulary are only covered when a medical necessity request is approved.
When you prescribe a formulary medication, AmeriHealth New Jersey members receive the drug for a lower out-of-pocket cost share. If you prescribe a drug not on the formulary (non-formulary), you must submit a medical necessity request. Instructions can be found on the prior authorization page.
See the latest value formulary changes (effective 4/1/2023)
See the latest value formulary changes (effective 1/1/2023)
The Select formulary
The Select formulary includes all generic drugs and a defined list of brand drugs that have been chosen for their reported medical effectiveness, positive results and value.
The Select formulary is designed to include all therapeutic categories and provide physicians with prescribing options. In addition, the formulary is reviewed periodically to add new drugs and to remove brand drugs when a generic equivalent becomes available.
See the latest Select formulary changes (effective 4/1/2023)
See the latest Select formulary changes (effective 1/1/2023)
The Standard Prescription Drug Program
The Standard Prescription Drug Program provides comprehensive prescription drug coverage. The member cost-sharing for this program is either a two-tier copayment structure of generic/brand or coinsurance.
List of preferred drugs
The list of preferred drugs is a comprehensive listing of preferred medications available to members who do not participate in the value or select formularies.
The list of preferred drugs helps members receive quality, affordable medications.
The list of preferred drugs has been organized into therapeutic classes and includes the generic and brand names of the drug. We encourage physicians to use the list to help members receive the lowest out-of-pocket expense. Medications on this list may be subject to the member’s contract exclusions and other pharmacy edits.
The list of preferred drugs can also be obtained by calling our Provider Supply Line at 1-800-858-4728.
Specialty pharmacy
AmeriHealth New Jersey offers two preferred options for participating providers to request fulfillment of specialty pharmacy drugs for patients with an AmeriHealth New Jersey prescription drug benefit: Optum® and PerformSpecialty®. Optum and PerformSpecialty supply specialty drugs eligible under the AmeriHealth New Jersey member’s prescription drug benefit, which is administered by an independent pharmacy benefits management (PBM) company.
Providers who are considering beginning an AmeriHealth New Jersey member on a new specialty drug therapy covered under the pharmacy benefit can use the following information:
- Optum. Providers can call Optum® Specialty Pharmacy and Optum® Infusion Pharmacy at 1-855-427-4682 to enroll the member. Members can reach Optum to have a prescription filled by calling 1-855-427-4682 or by visiting the Optum website.
- PerformSpecialty. Providers can call the PerformSpecialty patient care line at 1-855-287-7888 to enroll the member. Members can reach PerformSpecialty to have a prescription filled by calling their patient care line at 1-855-287-7888 or by visiting the PerformSpecialty website.
