Pharmacy and Prescription Benefits
On January 1, 2020, the Pennsylvania Department of Human Services (DHS) made changes in the way that some medicines are covered. All Pennsylvania Medical Assistance (Medicaid) health plans were required to move to a statewide preferred drug list (PDL). If you have any questions about this change, please call Participant Services at 1-855-235-5115 (TTY 1-855-235-5112).
AmeriHealth Caritas Pennsylvania (PA) Community HealthChoices (CHC) covers medicines that are:
- Medically necessary.
- Approved by the U.S. Food and Drug Administration (FDA).
- Prescribed by your health care provider.
Copays may apply to prescriptions.
How do pharmacy services work?
When you need medicine or over-the-counter items, your health care provider will write a prescription for you to take to the pharmacy. The following areas will help you learn more about where to get your medicine, which medicines are covered, and reimbursement for medicines.
Find a pharmacy
- Find a pharmacy.
This tool will help you find a pharmacy that takes AmeriHealth Caritas PA CHC in your area.
- Find a specialty pharmacy (PDF).
This document will help you find a specialty pharmacy in the AmeriHealth Caritas PA CHC network.
Find a medicine
- Dual-eligible Participants: Please refer to the drug list of your Medicare Part D plan.
- If you have AmeriHealth Caritas PA CHC as a secondary coverage, use our list of covered over-the-counter medicines. You can also view the printable version (PDF) here.
- If you have AmeriHealth Caritas VIP Care, use our Medicare Part D formulary.
- Medicaid LTSS Participants:
- AmeriHealth Caritas PA CHC Searchable Formulary
- AmeriHealth Caritas PA CHC Supplemental Formulary (PDF)
- Machine-readable formulary. (TXT)
- 90-Day Supply Medication List (PDF)
Some medicines may be filled for a 90-day supply. Talk with your doctor or pharmacist if you have questions about your medicines.
Other pharmacy information
- Reimbursement for medicine.
There may be times when you pay for your medicine. AmeriHealth Caritas Pennsylvania (PA) Community HealthChoices (CHC) may reimburse you, or pay you back.
- Prescription medicines.
Prescription medicines are prescribed by your health care provider to help keep you healthy, or treat you when you are sick. Copays may apply.
Please call Participant Services at 1-855-235-5115 (TTY 1-855-235-5112) if you have questions.