Ambetter·AL, AR, AZ, CA, DE, FL, GA, IL, IN, IA, KS, KY, LA, MI, MS, MO, NE, NV, NH, NJ, NY, NC, OH, OK, PA, SC, TN, TX, WA·Pharmacy
Effective date
Not stated
We identified it
Mar 31, 2026
Days to comply
—
Summary
Ambetter Health has updated their pharmacy program webpage outlining their preferred drug list coverage by state. The policy confirms that Ambetter covers prescription medications and certain over-the-counter medications when ordered by providers, but some medications require prior authorization or have limitations on age, dosage, and quantities.
Action Required
Action needed
Review Ambetter Health's state-specific preferred drug lists at https://www.ambetterhealth.com/select-your-state-enroll/coverage-area.html to understand which medications require prior authorization or have coverage limitations. Billing team should verify drug coverage before prescribing to avoid claim denials for non-covered medications.