Pharmacy & Prescription Drugs
ATTENTION: PHARMACY BENEFITS CHANGE EFFECTIVE OCTOBER 1, 2011
As of October 1, 2011, you will get your pharmacy benefit through Amerigroup. Be sure you use your new card starting October 1, 2011, to fill your prescriptions. You will not be able to use your Medicaid benefit ID card for prescriptions after September 30, 2011.
Amerigroup works with Caremark to provide your pharmacy benefit. Starting October 1, 2011, when you need to fill your prescription, you must go to a pharmacy in the Caremark network.
Amerigroup has a list of preferred drugs, also called a formulary. Not every drug will be covered. If a drug is not covered, you or your pharmacist may need to talk to your doctor about changing to a drug on the list. Your copayments for drugs will not change. If there are any other pharmacy changes, we will let you know.
If you have any questions about your pharmacy benefit, please call our Member Services department at 1-800-600-4441 (TTY 1-800-855-2880), Monday through Friday from 8:00 a.m. to 6:00 p.m.
MEDICAID, FAMILY HEALTH PLUS, CHILD HEALTH PLUS, MANAGED LONG-TERM CARE PLAN COVERAGE
The Amerigroup Community Care pharmacy benefit covers a wide range of prescription and Over-The-Counter (OTC) medicines. More than 50,000 pharmacies across the U.S. participate with Amerigroup. To view a list of network pharmacies, please click on Find a Provider above. We even offer specialty pharmacy services for hard-to-find medicines which can be mailed either directly to your house or doctor's office when necessary.
Preferred Drug List
Amerigroup has a list of drugs your doctor can choose from. It is called a preferred drug list or formulary. It includes all medicines covered by Medicaid.
Your doctor may need to get approval from us for certain drugs. This is known as prior authorization. Your doctor's request for approval should include why a specific drug is required and how much is needed. For these certain drugs, your doctor must get approval from us before you can fill your prescription.
When there is a generic drug available, it will be covered. Generic drugs are equal to brand-name drugs and approved by the Food and Drug Administration. Requests for brand name drugs when generics are available will need prior authorization.
To view Amerigroup's Preferred Drug List, CLICK HERE >>.
Getting your prescription filled is easy!
Simply present the written prescription from your doctor to a participating network pharmacy. Or your doctor can call in the prescription to your local participating pharmacy. You will also need to show the pharmacy your Amerigroup ID card to have a prescription filled.
It is good to use the same pharmacy each time. This way your pharmacist will know about problems that may occur when you are taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about any medicines you are taking.
Frequently Asked Questions
Click on a question to see our answer.
How can I find out what pharmacies are in Amerigroup’s network?
You can look in your new member enrollment package for a list of pharmacies in Amerigroup’s network, or you can search our list of network pharmacies by clicking on Find a Provider above. You can also call Member Services at 1-800-600-4441, or ask your local pharmacy for help.
Are over-the-counter (OTC) products covered, and do I need a prescription?
Many OTC products are covered by Amerigroup, including pain relievers, antacids, contraceptives and some vitamins. All OTC products require a written prescription from your doctor and can be filled at any network pharmacy.
How does my doctor request prior authorization?
Your doctor can request prior authorization on medicines by calling Amerigroup’s Pharmacy Department at 1-800-454-3730.
What if a copay is required and I am unable to pay it?
If you don’t have the copay for your medicine, your pharmacy should still provide the medicine. If the pharmacy allows you to take the medicine without paying the required copay, you will have to pay the copay at a later time.
How do I get my medicine if I am traveling?
Amerigroup has network pharmacies in all 50 states. Most chain pharmacies as well as many independent and grocery store pharmacies participate. If you need a refill while on vacation, contact your doctor for a new prescription to take with you. To view a list of network pharmacies, please click on Find a Provider above.
What happens if my medicines are lost or stolen?
If your medicines are lost or stolen, you should contact your doctor to authorize the pharmacy to refill your prescription early. The pharmacy may have to contact Amerigroup for prior approval. Replacement of lost or stolen medicines will be reviewed on a case-by-case basis.
What if I paid out of pocket for a medicine and want to be reimbursed?
If you had to pay for a medicine, you may submit a request for reimbursement. You’ll need to mail the completed Reimbursement Request Form along with any receipts to:
Amerigroup Community Care
Pharmacy Department
PO Box 62509
Virginia Beach, VA 23466-2509