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Pharmacy policy

Terms and Conditions

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  • The Policy Bulletins on this website were developed to assist AmeriHealth in administering the provisions of its benefits programs and do not constitute medical advice. If you are an AmeriHealth member, please refer to your specific benefit program for the terms, conditions, limitations, and exclusions of your coverage. Facility and professional providers, such as hospitals and physicians, are responsible for providing medical advice and treatment. If members have a specific medical condition or question, they should consult with their provider.
  • Please note that the Policy Bulletins are updated when new medical evidence becomes available and, therefore, are subject to change. Policy Bulletins are reviewed and updated at least annually.
  • You should be aware that Policy Bulletins are used as a guide only. Coverage decisions are made by applying Policy Bulletin criteria to the member’s medical history, condition, and proposed course of treatment as well as the member’s benefit program. Members should review the Policy Bulletins with their providers because the Policy Bulletins are designed to be used by our professional staff in making coverage determinations and can be highly technical.
  • Information contained in the Policy Bulletins does not constitute an offer of coverage, medical advice, or guarantee of payment. Please note that if there is a conflict between the Policy Bulletin and a member’s benefit program, the terms of the benefit program will govern.
  • For Pharmacy Policies the policies listed on this site only apply to the Select Formulary and Value Formulary.

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