AmeriHealth policy updates
Track new and updated AmeriHealth policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Preventive HIV Pre-Exposure Prophylaxis (PrEP) Medications Coverage | AmeriHealth | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| Quantity limits — Premium Formulary (Premium Non‑Specialty) | AmeriHealth | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| Step therapy Premium Formulary — Step therapy program (drug step therapy list) | AmeriHealth | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| Select Drug Program Formulary | AmeriHealth | Reimbursement | — | Modified | Apr 1, 2026 |
| AmeriHealth Medicare PPO 2026 Formulary (Drug List) | AmeriHealth | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| AmeriHealth Medicare PPO 2026 Formulary (Drug List) | AmeriHealth | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| Select Drug Program Formulary (pharmacy benefit) — Coverage Criteria | AmeriHealth | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| Specialty drugs requiring precertification | AmeriHealth | Clinical | Pharmacy & Specialty Drugs | Modified | Jan 1, 2026 |
| AmeriHealth Medicare PPO 2025 Formulary (Drug List) | AmeriHealth | Clinical | Pharmacy & Specialty Drugs | Modified | Oct 17, 2025 |
| Precertification Requirements for Elective (Non‑Emergency) Services | AmeriHealth | Administrative | — | Modified | Jul 1, 2025 |
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OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.