We are committed to providing appropriate, high-quality, and cost-effective drug therapy to all Ambetter Health members.

• 2025 Formulary/Prescription Drug List - English/Spanish (PDF)
  
• 2025 Formulary Changes (PDF)
• 2024 Formulary/Prescription Drug List - English/Spanish (PDF)
• 2024 Formulary/Prescription Drug List - Simplified Chinese (PDF)
• 2024 Formulary/Prescription Drug List - Traditional Chinese (PDF)
• 2024 Formulary/Prescription Drug List - Vietnamese (PDF)
• 2024 Formulary Changes (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)
• Download Prescription Claim Reimbursement Form - Simplified Chinese (PDF)
• Download Prescription Claim Reimbursement Form - Traditional Chinese (PDF)
• Download Prescription Claim Reimbursement Form - Vietnamese (PDF)
• Prior Authorization Form - Prescription Drug Requests (PDF)

Save Money and Get Your Prescriptions Delivered to Your Door!

Prescription Delivery

As an Ambetter Health member, you can maximize your pharmacy benefits by filling your prescriptions by mail. Eligible members may save when ordering a 90-day supply*. 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 provider and ask them to send a new 90-day prescription to Express Scripts® Pharmacy. 
2. Or request prescription delivery in your online member account.  

*Members may save when they fill eligible medications, 90 days at a time, through Express Scripts® Pharmacy. 

AcariaHealth

Looking for a specialty pharmacy to help navigate your complex or chronic condition? AcariaHealth is here to support you along your health care journey.

Get your specialty medications mailed directly to your door. AcariaHealth offers convenient 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. Their team will work with your current specialty pharmacy provider to ensure a safe and seamless transition of your medications.

Learn more about how AcariaHealth can support you with your complex or chronic condition.

Hemophilia Network

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

• Ambetter Health In-Network Hemophila Pharmacies