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Member benefits

Pharmacy services

AmeriHealth Caritas Louisiana members are eligible for pharmacy benefits. If you need medicine, your doctor will write you a prescription to take to a participating pharmacy. Find a list of participating pharmacies using Find a Pharmacy. You can also get a hard copy of the AmeriHealth Caritas Louisiana participating pharmacy directory by calling Pharmacy Member Services at 1-866-452-1040.

Prescriptions

Your doctor will write a prescription for medicine and over-the-counter (OTC) drugs when you need it to be filled by your pharmacist. AmeriHealth Caritas Louisiana covers medicines that:

  • Are medically necessary
  • The Food and Drug Administration (FDA) approves
  • Are not excluded by the Louisiana Medicaid program
  • Are prescribed by a licensed health care professional

Drug formulary (list of medicines)
Your drug formulary is the list of medicines AmeriHealth Caritas Louisiana covers. This list helps your health care provider prescribe medicines for you. Brand name and generic medicines are on the drug formulary. AmeriHealth Caritas Louisiana requires that generic medicines be used when available. If a certain medicine is not listed on the drug formulary, your doctor may ask for it through AmeriHealth Caritas Louisiana’s prior authorization (pre-approval) process. View the drug formulary list (PDF).

Prior authorization (pre-approval)
Some medicines on the AmeriHealth Caritas Louisiana formulary and all medicines not on the AmeriHealth Caritas Louisiana formulary require prior authorization by AmeriHealth Caritas Louisiana. If your doctor writes a prescription for a medicine that requires prior authorization, your doctor will need to send us a prior authorization request form. We will review it and let your doctor know our decision. AmeriHealth Caritas Louisiana will cover the medicine if it is medically-necessary. If it is not medically-necessary, we will send you a letter that will tell you why. The letter will explain how to make an appeal if you want to do so.

Co-pays
Some adult members will need to pay a small co-pay for their prescriptions. The co-pays for medication are as follows:

Co-pay calculated state payment

Co-payment amount Calculated state payment
$0.50 $10.00 or less
$1.00 $10.01 to $25.00
$2.00 $25.01 to $50.00
$3.00 $50.01 or more

There will be no co-pay for members who are:

  • Less than 21 years of age
  • Pregnant
  • Receiving emergency services
  • Living in long-term care facilities or other institutions
  • Federally-recognized Native Americans or Alaskan Eskimos

Show your AmeriHealth Caritas Louisiana member ID card when you get your prescriptions. If you have questions, call Pharmacy Member Services at 1-866-452-1040.

Over-the-counter medicine

AmeriHealth Caritas Louisiana covers some over-the-counter medicines. You must have a prescription from your doctor. Some examples of OTC medicines covered by AmeriHealth Caritas Louisiana are:

  • Sinus and allergy medicines
  • Pain medicine, such as acetaminophen, naproxen, and ibuprofen
  • Heartburn medicine, such as antacids and famotidine

Please see the AmeriHealth Caritas Louisiana formulary for covered OTC medicines and any restrictions that may apply.

Continuity of care (transition supply)

AmeriHealth Caritas Louisiana will provide a supply of the medicines you take on a regular basis for chronic conditions (maintenance medicines) that are not on the AmeriHealth Caritas Louisiana formulary for at least 60 days after you transition from the fee-for-service pharmacy program.

Participating pharmacies

You can get pharmacy services at any participating AmeriHealth Caritas Louisiana pharmacy. Find a list of participating pharmacies using Find a Pharmacy or call Pharmacy Member Services at 1-866-452-1040.

Family planning services

AmeriHealth Caritas Louisiana covers family planning supplies provided through a participating pharmacy. There are no
co-pays for these supplies.

Pharmacy member services

If you have questions, please call Pharmacy Member Services at 1-866-452-1040. TTY users, please call 1-855-294-7047.