Reimbursement for Medicines
There may be times when you pay for your medicine. AmeriHealth Caritas Next may reimburse you, or pay you back.
Generally, reimbursement is NOT made for medicines that:
-
Need prior authorization
-
Are not covered by either AmeriHealth Caritas Next.
-
Are not medically necessary
-
Go over certain dose and supply limits set by the Food and Drug Administration (FDA)
-
Are re-filled too soon
You cannot be reimbursed if:
- You were not eligible for pharmacy benefits when you paid for the medicine.
- You were not an AmeriHealth Caritas Next member when you got the medicine filled.
- The prescription(s) you were seeking reimbursement for was/were purchased from an out-of-network pharmacy for a nonemergency event. If an out-of-network pharmacy was used due to an emergency event, please provide explanation and/or documentation of the nature of the emergency with all of the documentation for reimbursement.
How to get reimbursed
You must ask for reimbursement in writing*. You must send a detailed receipt from the pharmacy that includes:
- Member’s name
- Date you bought the medicine
- Drug store name, address (city, state, and zip code) and phone number
- Name, strength, and amount of medicine
- National Drug Code (NDC) number of medicine (if you are not sure about this information, ask the pharmacist to help you)
- Total amount you paid for each medicine
Write your name, address, phone number, and AmeriHealth Caritas Next ID number on your receipt or another piece of paper. Send all of this information to:
It may take 6 – 8 weeks before you get your payment.
NOTE: A receipt that does not have all of the above information will NOT be reimbursed and will be returned to you. Receipts should be sent to AmeriHealth Caritas as soon as possible. Receipts older than 365 days will not be accepted. Please remember to keep a copy of the receipt for your records.
*If you need help writing your reimbursement request, call Member Services at 1-833-999-3567 (TTY 711).