Pharmacy Prior Authorizations

Prior authorization is required for certain drugs prescribed to AmeriHealth Caritas members. Our Pharmacy Services department at AmeriHealth Caritas North Carolina reviews pharmacy prior authorizations to make sure your prescribed medications are safe and appropriate.

Reasons your medication may require preauthorization:

  • 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.

See Pharmacy 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