CommercialPrior AuthMedium impact
Upcoming changes to the list of specialty drugs that will require precertification
AmeriHealth New Jersey·NJ·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
AmeriHealth is updating their list of specialty drugs that require precertification under the medical benefit. This change affects AmeriHealth HMO, AmeriHealth Insurance Company of New Jersey, and AmeriHealth Administrators for Commercial and Medicare Advantage plans.
Action Required
By June 30, 2026: Billing team must obtain the updated specialty drug precertification list from AmeriHealth and update prior authorization workflows in billing system. Review current specialty drug claims to identify which will require new precertification requirements. Train staff on new precertification requirements for affected specialty drugs under medical benefit.