• 2023 Formulary/Prescription Drug List (PDF)
  
• 2023 Formulary Changes (PDF)
  
• 2022 Preferred Drug List (PDF)
• Extended Day Supply Pharmacies are now listed in our Find a Provider tool
  
• 90-Day Extended Supply Medications (PDF)

Forms

• Download Prescription Claim Reimbursement Form - English (PDF)
• Download Prescription Claim Reimbursement Form - Spanish (PDF)
• Complaint Appeal Request Form (PDF)
• Compliment or Complaint/Grievance Submission Form (PDF)
• Prior Authorization Appeal Form (PDF)

Save Money and Get Your Prescriptions Delivered to Your Door!

CVS Mail Order

As an Ambetter member, you can maximize your pharmacy benefits by filling your prescriptions with CVS Caremark Mail Service Pharmacy, the only in-network mail order pharmacy. Eligible members pay only 2.5x* their regular copay for a three-month fill. Delivery is free and can be to your home, workplace, or any address you choose.

Prescription delivery may be right for you if you take medications regularly for conditions like high blood pressure, arthritis or diabetes.

Two easy ways to get started:

1.  Call your doctor and ask them to send a new 90-day prescription to CVS Caremark Mail Service Pharmacy.

2.  Or, request a new 90-day prescription at Caremark.com.

*2.5x copay is only applicable for three-month mail order
fills from CVS Mail Order. All other three-month mail order fills will be
subject to the standard 3x copay.

AcariaHealth

Need a specialty pharmacy for your complex or chronic conditions? Prescription home delivery is available to you.

Get your specialty medications mailed directly to your door, free of charge. AcariaHealth offers specialty prescription delivery services for those living with complex conditions or chronic illnesses, such as rheumatoid arthritis, multiple sclerosis, hepatitis C or cancer. AcariaHealth’s licensed pharmacists are also available to you 24/7 to discuss prescribed therapy and answer any questions regarding medications and supplies.

AcariaHealth will work with your current specialty pharmacy provider to seamlessly transition your medications safely and efficiently. To get started, contact us at 1-800-511-5144.

• AcariaHealth FAQs (PDF)
• AcariaHealth Overview (PDF)

Hemophilia Network

Please refer to the link below for a comprehensive listing of Ambetter’s in-network hemophilia pharmacies.

• Ambetter In-Network Hemophilia Pharmacies