Pharmacy benefits

Medicaid and Alliance enrollees Drug Formulary

Prior authorization criteria (PDF)

PerformRx, an affiliate of AmeriHealth Caritas DC and an enrollee of the AmeriHealth Caritas Family of Companies, is the delegated manager of pharmacy services covered by the AmeriHealth Caritas DC health plan. 

Important Information

Pharmacy prior authorization forms

Specialty prior authorization forms

Using our online Web submission tool, providers are able to:

  • Electronically submit all relevant enrollee information.
  • Attach enrollee-specific documents such as labs, chart notes, consults, etc.
  • Submit requests to PerformRx instantly.
  • Reduce prior authorization review time.
  • Obtain instant approvals for specific drugs.
  • Save unique provider information in order to expedite future Web submissions.
  • Print summary page for easy referencing.

HIV/AIDS medicines
Medications used for the treatment of HIV/AIDS are managed directly by the District's Department of Health and should be billed to fee of service. For more information, please call 202-671-4900.

Important numbers

Pharmacy Provider Services

Medicaid - 1-888-602-3741
Alliance - 1-888-987-5821 

Pharmacy Enrollee Services

Medicaid - 1-888-452-3647
Alliance - 1-888-987-5806

Pharmacy prior authorization fax

1-855-811-9332

Pharmacy TTY/TDD

1-888-989-0073

Specialty Pharmacy

PerformSpecialty is everything you expect from a specialty pharmacy and more. Our pharmacy was created specifically to meet the needs of AmeriHealth Caritas DC enrollees and providers; everything we do is focused on delivering the highest quality of care to your patients. We offer:

  • 24/7 patient support
  • Patient support programs
  • Medication adherence programs
  • Complete pharmaceutical care management

For more information, visit PerformSpecialty or contact PerformSpecialty at 1-855-287-7888.

We partner with several specialty pharmacies including Excel Pharmacy, PerformSpecialty, and other limited distribution pharmacies based on the needs of our enrollees.

Other important information

Transition supply

New enrollees to the plan are eligible for a transition supply of non-formulary medications during their first 60 days of enrollment with the plan.

Over-the-counter medications

Certain generic over-the-counter medications are covered by AmeriHealth Caritas DC with a prescription from the prescribing physician and are limited to a 34-day supply. These include, but are not limited to, aspirin, acetaminophen, ibuprofen, cough and cold preparations, tobacco cessation products and antihistamines.

Whom to contact if you have questions:

  • Enrollees can call our Pharmacy Enrollee Services team at 1-888-452-3647 (TTY/TDD: 1-888-989-0073) if they need help or have questions.
  • Call PerformRx Pharmacy Services at 1-888-602-3741 to obtain the enrollee's new ID number or if you have any questions or problems.
Providers