Estamos comprometidos con brindar terapia farmacológica apropiada, de alta calidad y rentable a todos los miembros de Ambetter. Use nuestra Lista de medicamentos preferidos para encontrar más información sobre los medicamentos que Ambetter cubre.

• 2020 Preferred Drug List (PDF)
• 2019 Preferred Drug List (PDF)
• 90 Day Maintenance Drug List (PDF)

PA Forms

• Prior Authorization Request Form for Non-Specialty Drugs (PDF)
• Prior Authorization Request Forms for Specialty Drugs
• For Medical “J-Code” or “buy-and-bill” prior authorization requests, please submit the request through our Secure Provider Portal.

Oncology Prior Authorization Requests

Pre-approval Process 

The requesting physician must complete an authorization request using one of the following methods: 

• Logging into the NCH Provider Web Portal: https://my.newcenturyhealth.com 
• Calling 1-877-624-8601 (Monday – Friday 5 a.m. to 5 p.m. PST) 
• Faxing the authorization form to 1-877-624-8602 

Please note: 

Inpatient requests for chemotherapy should continue to be submitted via our Secure Provider Portal.

Pharmacy dispensed chemotherapeutic and supportive agents that were previously submitted to Envolve Pharmacy Solutions or CoverMyMeds should be submitted directly to NCH.