Prior authorization

For members who have prescription drug coverage through AmeriHealth New Jersey, prior authorization is required for coverage of certain prescribed covered drugs that have been approved by the U.S. Food and Drug Administration (FDA) for specific medical conditions. The approval criteria were developed and endorsed by the AmeriHealth New Jersey Pharmacy and Therapeutics Committee and are based on information from the FDA, manufacturers, medical literature, actively practicing consultant physicians and appropriate external organizations.

All requests will be reviewed by our pharmacy benefits manager (PBM), on behalf of AmeriHealth.

A request form must be completed for all medications that require prior authorization. Submit by fax using our PBM commercial forms.

Request form instructions:

  1. When completing a prior authorization form, all requested information on the form must be supplied.
  2. Please fax completed forms to our PBM at 888-671-5285 for review. Make sure you include your office telephone and fax numbers.
  3. You will be notified by fax if the request is approved. If the request is denied, you and your patient will receive a denial letter.
  4. If you have not received a response after two business days from when you submitted your completed form, please call our PBM at 888-678-7012.

As with all our preauthorization requirements, the prior authorization form must be completed in full to avoid delay. If you have questions about the preauthorization process, call 888-YOUR-AH1.