← Back to list
Specialty drug precertification updates take effect January 1, 2027
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 20, 2026
Summary
AmeriHealth will update its list of specialty drugs requiring precertification under medical benefits effective January 1, 2027. This change affects members in AmeriHealth HMO plans, AmeriHealth Insurance Company of New Jersey plans, and AmeriHealth Commercial and Medicare Advantage PPO plans administered by AmeriHealth Administrators. Billing teams must verify the updated specialty drug precertification list and adjust prior authorization workflows accordingly.
Get alerts when payers change rules like this one
We check AmeriHealth New Jersey and other payers every day and email you when a change matches your specialty and state.
Get AmeriHealth New Jersey alertsPolicy Monitoring is free. No card required.
What to do
by Jan 1, 2027 · 4 steps
01Billing team and clinical staff must obtain and review the updated specialty drug precertification list from AmeriHealth Administrators.
02Update the practice's prior authorization protocols and billing system to reflect which specialty drugs now require precertification under the medical benefit.
03Verify current applicability with AmeriHealth for the specific plan types your practice serves (HMO, Commercial PPO, Medicare Advantage PPO).
04Train staff on new precertification requirements to prevent claim denials for specialty drugs.
Original notice
Specialty drug precertification updates take effect January 1, 2027
provcomm.amerihealth.com · Always check the source before changing claims.