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Member Lock-In Program

AmeriHealth Caritas Delaware’s lock-in program assigns members to a specific pharmacy 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.

Provider referrals

Providers can refer members to our lock-in program if they suspect misuse, abuse, or potential fraud of pharmacy services. If you suspect member fraud, misuse, or abuse of services, you are encouraged to make a referral to the Pharmacy and PCP Lock-In programs by calling the Fraud and Abuse Hotline at 1-866-833-9718.