Pharmacy Prior Authorizations

The Pharmacy Services department at AmeriHealth Caritas New Hampshire issues prior authorizations to allow processing of prescription claims for nonpreferred or other drugs on the New Hampshire preferred drug list (PDL) (PDF) that require prior authorization.

How to submit a request for pharmacy prior authorizations

Online

• Complete the online pharmacy prior authorization request form.
• Complete the online behavioral health pharmacy prior authorization request form for CMHC use only.

By phone

Call 1-888-765-6394, 8 a.m. to 5 p.m., Monday through Friday.

After business hours, Saturday, Sunday, and holidays, call Member Services at 1-888-765-6383.

By fax

• AmeriHealth Caritas New Hampshire: 1-866-880-3679.
• AmeriHealth Caritas New Hampshire — CMHC: 1-855-839-3883.

Prior authorization criteria

• Prior authorization drug approval form (PDF)
• Prior authorization drug approval form (PDF) for CMHC use only.

Drug-Specific Prior Authorization Forms

• Hepatitis C (PDF)
• Long-Acting Opioid Analgesic Medications (PDF)
• PCSK9 (PDF)
• Synagis (PDF)

Emergency supply

In the event a member needs to begin therapy with a noncovered medication before you can obtain prior authorization, pharmacies are authorized to dispense up to a 72-hour emergency supply.

The pharmacy must enter a "3" in the Level of Service field (418-DI) to indicate that the transaction is an emergency fill. The claims will only allow a 72-hour supply. Emergency fills will be exempt from copayments.