Pharmacy Program
AI Summary
Ambetter Health has updated their pharmacy program webpage outlining their preferred drug list coverage by state. The policy confirms that Ambetter covers prescription medications and certain over-the-counter medications when ordered by providers, but some medications require prior authorization or have limitations on age, dosage, and quantities.
Action Required
Review Ambetter Health's state-specific preferred drug lists at https://www.ambetterhealth.com/select-your-state-enroll/coverage-area.html to understand which medications require prior authorization or have coverage limitations. Billing team should verify drug coverage before prescribing to avoid claim denials for non-covered medications.
Plan Types
Exchange
States
AL, AR, AZ, CA, DE, FL, GA, IL, IN, IA, KS, KY, LA, MI, MS, MO, NE, NV, NH, NJ, NY, NC, OH, OK, PA, SC, TN, TX, WA
Specialties
all-specialties