Member Benefits
Pharmacy services
AmeriHealth Caritas Louisiana members are eligible for pharmacy benefits. If you need medicine, your doctor will write you a prescription to take to a participating pharmacy. Find a list of participating pharmacies using Find a Pharmacy. 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 (TTY 711).
Prescriptions
Your doctor will write a prescription for medicine and over-the-counter (OTC) drugs when you need it to be filled by your pharmacist. AmeriHealth Caritas Louisiana covers medicines that:
- Are medically necessary
- The Food and Drug Administration (FDA) approves
- Are not excluded by the Louisiana Medicaid program
- Are prescribed by a licensed health care professional
Drug formulary (list of medicines)
Your drug formulary is the list of medicines the Louisiana Department of Health (LDH) tells AmeriHealth Caritas Louisiana to cover. This list helps your health care provider prescribe medicines for you. 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. View the Louisiana Medicaid Single PDL (Fee for Service and Managed Care Organizations) (PDF).
Prior authorization (pre-approval)
Some medicines on the Louisiana Medicaid Single PDL (Fee for Service and Managed Care Organizations) (PDF) require prior authorization by AmeriHealth Caritas Louisiana. If your doctor writes a prescription for a medicine that requires prior authorization, your doctor will need to send us a prior authorization request form. We will review it and let your doctor know our decision.
AmeriHealth Caritas Louisiana will cover the medicine if it is medically-necessary. If it is not medically-necessary, we will send you a letter that will tell you why. The letter will explain how to make an appeal if you want to do so.
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.
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.
Participating pharmacies
You can get pharmacy services at any participating AmeriHealth Caritas Louisiana pharmacy. Find a list of participating pharmacies using Find a Pharmacy or call Pharmacy Member Services at 1-800-424-1664.
Family planning services
AmeriHealth Caritas Louisiana covers family planning supplies provided through a participating pharmacy. There are no co-pays for these supplies.
Pharmacy member services
If you have questions, please call Pharmacy Member Services at 1-800-424-1664 (TTY 711).