Pharmacy services
Pharmacies are where you pick up your medicines (drugs). If your doctor gives you a prescription, you must go to a pharmacy in AmeriHealth Caritas Louisiana's network.
Find an AmeriHealth Caritas Louisiana pharmacy
To find a pharmacy, view our pharmacy directory. You can also get a hard copy of the AmeriHealth Caritas Louisiana participating pharmacy directory by calling Pharmacy Member Services at 1-800-424-1664.
Approved medicines
The drug formulary is the list of medicines AmeriHealth Caritas Louisiana covers. This list helps your doctor prescribe medicines for you.
See the Louisiana Medicaid Single PDL (Fee for Service and Managed Care Organizations) (PDF).
Brand name and generic medicines are on the drug formulary. AmeriHealth Caritas Louisiana requires that generic medicines be used when available.
If a certain medicine is not listed on the drug formulary, your doctor may ask for it through AmeriHealth Caritas Louisiana's prior authorization (pre-approval) process.
Prescriptions
Your doctor will write a prescription for medicine and over-the-counter drugs when you need it. AmeriHealth Caritas Louisiana covers medicines that:
- Are medically necessary
- The Food and Drug Administration (FDA) approves
- Are not excluded by the Louisiana Medicaid program, and
- A doctor prescribes
To get a prescription filled:
- Pick a pharmacy that is part of the AmeriHealth Caritas Louisiana network and is close to your work or home.
- Take your prescription to the pharmacy. Give it to the pharmacist along with your AmeriHealth Caritas Louisiana Member ID Card, LDH ID card and any other health insurance card(s) you have.
If you are out of town and you have an emergency or need urgent care and need a prescription filled, call Pharmacy Member Services at 1-800-424-1664.
Copays
Effective January 1, 2020 AmeriHealth Caritas of Louisiana will implement measures to ensure that copays of Medicaid family members do not exceed five percent of the family income. Copay amounts will stop once the monthly threshold is met.
Some adult members will need to pay a small copay for their prescriptions. The co-pays for medication are as follows:
Copay calculated state payment
| Copayment amount | Calculated state payment | |
|---|---|---|
| $0.50 | $10.00 or less | |
| $1.00 | $10.01 to $25.00 | |
| $2.00 | $25.01 to $50.00 | |
| $3.00 | $50.01 or more |
There will be no copay for members who are, for example:
- Less than 21 years of age
- Pregnant
- Receiving emergency services
- Living in long-term care facilities or other institutions
- Federally recognized Native Americans or Alaskan Eskimos
Show your AmeriHealth Caritas Louisiana member ID card when you get your prescriptions. If you have questions, call Pharmacy Member Services at 1-800-424-1664.
Prior authorization (pre-approval)
Your doctor may write a prescription for a medicine that is not on the Louisiana Medicaid Single PDL (Fee For Service and Managed Care Organizations) (PDF). Your doctor will need to send us a prior authorization request form (PDF). We will review and let your doctor know our decision.
If AmeriHealth Caritas Louisiana does not approve the medicine, you will get a letter that will tell you why. The letter will tell you how to make an appeal if you want to do so.
Continuity of care (transition supply)
AmeriHealth Caritas Louisiana will provide a supply of the medicines you take on a regular basis for chronic conditions (maintenance medicines) that are not on the Louisiana Medicaid Single PDL (Fee for Service and Managed Care Organizations) (PDF) for 60 days after you become an AmeriHealth Caritas Louisiana member.
Family planning services
AmeriHealth Caritas Louisiana covers family planning supplies provided through a participating pharmacy. There are no co-pays for these supplies, such as birth control medications.
Pharmacy member services
If you have questions, please call the Pharmacy Member Services toll-free at 1-800-424-1664. TTY users, call 711.
New members
- If you don't yet have an ID card when you go to fill your prescription, tell the pharmacy to call Pharmacy Provider Services at 1-800-424-1664. We will look up your member ID number and share it with your pharmacy.
- Call our Pharmacy Member Services team at 1-800-424-1664 (TTY 711) if you need help or have questions.
Do more online. Don't wait until you run out. Get automatic refill reminders in the member portal.