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Formulary (list of covered drugs)
A formulary is a list of drugs, or prescriptions, that a plan covers. AmeriHealth Caritas VIP Care (HMO-SNP) will generally cover the drugs listed in our formulary as long as the drugs are medically necessary. The prescription also needs to be filled at a network pharmacy, and other plan rules need to be followed. For more information on how to fill your prescriptions, see the AmeriHealth Caritas VIP Care Evidence of Coverage (PDF).
The formulary has been reviewed and approved by the Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare. Formulary medications are approved by the U.S. Food and Drug Administration (FDA), and have been chosen for their reported medical effectiveness and value. The formulary is updated at times throughout the year, and the list of drugs may change.
AmeriHealth Caritas VIP Care covers both brand name drugs and generic drugs. Generic drugs have the same active ingredient as brand name drugs. Generic drugs usually cost less than brand name drugs and are rated by the FDA to be as safe and effective as brand name drugs.
Want regular information about your pharmacy benefits? Look out for your monthly explanation of pharmacy benefits in the mail.
Prescription drug frequently asked questions (FAQs)
AmeriHealth Caritas VIP Care 2025 drug formulary
- Searchable online formulary
- Printable comprehensive formulary (PDF) posted November 11, 2024
- Machine-readable list of covered drugs (is in accordance with CMS standard) (JSON)
- Prior authorization criteria (PDF)
- Step therapy criteria (PDF)
- Prescription drug frequently asked questions (FAQs)
Answers to commonly asked questions, like "What if my drug is not on the formulary?" and "What are over-the-counter (OTC) drugs?" - Find a pharmacy
Formulary updates
- Formulary updates (PDF)
View and/or print the formulary updates - Preferred diabetic supplies (PDF)
Please find updates to Preferred Diabetic Supplies effective April 29, 2024. For questions, please contact Member Services at 1-833-535-3767 (TTY 711), 8 a.m. – 8 p.m., Monday through Friday, from April 1 to September 30. From October 1 to March 31, 8 a.m. – 8 p.m., seven days a week.