Pharmacy Prior Authorizations
The Pharmacy Services department at AmeriHealth Caritas New Hampshire issues prior authorizations to allow processing of prescription claims for nonpreferred or other drugs that require prior authorization.
View our searchable formulary to see if prior authorization is required.
How to submit a request for pharmacy prior authorizations
Online
To submit electronically, please submit an Electronic Prior Authorization (ePA) through your Electronic Health Record (EHR) tool software, or through either of the following online portals:
By phone
- Call 1-888-765-6394, 8 a.m. to 5 p.m., Monday through Friday.
- After business hours, Saturday, Sunday, and holidays, call Member Services at 1-888-765-6383.
By fax
- AmeriHealth Caritas New Hampshire: 1-866-880-3679.
- AmeriHealth Caritas New Hampshire — CMHC: 1-855-839-3883.
Prior authorization criteria
Many medicines have specific requirements and conditions that must be met to receive prior authorization. Save time by viewing a list of medications and their prior authorization criteria (PDF) before submitting your request.
Prior Authorization Drug Approval Forms
- Prior authorization drug approval form (PDF)
- Prior authorization drug approval form (PDF) for CMHC use only.
Drug-Specific Prior Authorization Forms
- Antihemophilia agents (PDF)
- Hepatitis C medications(PDF)
- Long-acting opioid analgesic medications (PDF)
- PCSK9 (PDF)
- Synagis (PDF)
Emergency supply
In the event a member needs to begin therapy with a noncovered medication before you can obtain prior authorization, pharmacies are authorized to dispense up to a 72-hour emergency supply.
The pharmacy must enter a "3" in the Level of Service field (418-DI) to indicate that the transaction is an emergency fill. The claims will only allow a 72-hour supply. Emergency fills will be exempt from copayments.