Pharmacy Prior Authorizations

Prior authorization is required for certain drugs prescribed to AmeriHealth Caritas North Carolina members. Our Pharmacy Services department reviews pharmacy prior authorizations for safety and appropriateness.

Reasons a medication may require prior authorization:

  • The medication is not preferred, and other alternatives are recommended.
  • The dose is outside FDA recommendations.
  • The medication is a high risk for abuse or misuse.
  • The medication requires additional information.

Please note the following information is for Medicaid plan prior authorizations. Providers requesting prior authorization for AmeriHealth Caritas Next members will find guidance on their website.

See Program Specific Clinical Coverage Policies for more details, including pharmacy prior authorization criteria.

How to submit a request for pharmacy prior authorizations

  • Download and complete the appropriate prior authorization form from the list below. 
  • Fax your completed Prior Authorization Request form to 1-877-234-4274, or call 1-866-885-1406, 7 a.m. to 6 p.m., Monday through Saturday.

If you have questions after business hours (Sunday and holidays), call Member Services at 1-855-375-8811 (TTY 1-866-206-6421).

For general pharmacy prior authorization requests (drugs or classes that do not have a form below), complete the Online Pharmacy Prior Authorization Request Form.

Emergency supply

In the event a member needs to begin therapy with a medication before you can obtain prior authorization, pharmacies are authorized to dispense up to a 72-hour emergency supply.

Prior authorization forms

Download and submit the following forms to submit pharmacy prior authorization requests.

Providers