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Member Lock-In Program

AmeriHealth Caritas Iowa’s lock-in program assigns members to a specific pharmacy for up to two years to prevent and reduce the misuse of pharmacy services.

Lock-in notice

A multi-disciplinary team reviews member medical and pharmacy utilization. If the team finds evidence of misuse, abuse, or potential fraud of pharmacy services from a member, they will lock-in the member and send notice to:

  • The member
  • The member's primary care provider
  • The pharmacy assigned to the lock-in member

Each notice will detail the member’s lock-in assignment to a pharmacy for up to two years.

Provider referrals

Providers can refer members to our lock-in program if they suspect misuse, abuse, or potential fraud of pharmacy services. Simply use our secure contact form or call Pharmacy Member Services at 1-855-332-2440 and ask to speak to the Member Lock-in Program coordinator. 

  • Please complete all of the member’s information in the appropriate fields.
  • Put the member's AmeriHealth Caritas Iowa ID in the Provider/Member ID field.
  • Provide your email address in that field.
  • Choose “Pharmacy – Lock-in Referral” as the subject.
  • Add any comments that you feel may be helpful, such as:
    • Examples of how the member might be misusing or abusing medical and/or pharmacy services.
    • Examples of specific pharmacies, providers, or drugs that cause concern and why.

Providers

Contact Pharmacy Member Services at 1-855-332-2440 and ask to speak to the Member Lock-In Program Coordinator.

Members

A member may also voluntarily choose to be part of the lock-in program by calling 1-855-248-0453 or using the secure contact form.