Pharmacy

We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter members. Use our Preferred Drug List to find more information on the drugs that Ambetter covers.

• 2019 Preferred Drug List (PDF)
• 90 Day Maintenance Drug List (PDF)

PA Forms

• Prior Authorization Request Form for Non-Specialty Drugs (PDF)
• Prior Authorization Request Forms for Specialty Drugs
• For Medical “J-Code” or “buy-and-bill” prior authorization requests, please submit the request through our Secure Provider Portal.