New Fax Number

New fax number for Ambetter Pharmacy Benefit Prior Authorization requests: 1-800-977-4170

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.

2022 Preferred Drug List (PDF).
2021 Preferred Drug List (PDF).
2020 Preferred Drug List (PDF)
90-Day Extended Supply Medications (PDF)

PA Forms

CoverMyMeds
Prior Authorization Request Form for Non-Specialty Drugs (PDF)
Prior Authorization Request Forms for Specialty Drugs

Pennsylvania Pharmacy Resources for Providers | Ambetter from PA Health & Wellness

New Fax Number

Pharmacy

PA Forms