Pharmacy and prescription drug benefits

Copays

Your copay for prescriptions is $3 for brand-name drugs. There’s no copay for generic drugs. Members under age 21 and pregnant women do not have a copay..

Preferred drugs and formulary

Preferred Drug List (PDL)

Amerigroup has a list of preferred drugs chosen for their quality and effectiveness. It’s called a Preferred Drug List (PDL).

Many of the drugs listed on the PDL do not need preapproval. Drugs not listed on the PDL always require preapproval. This means your doctor must get approval from us before he or she can write a prescription for the drug. Go to the preapprovals section, below, for more information.

The PDL can change at any time. Please check back for updates.

• Preferred Drug List – English
• Preferred Drug List – Spanish

You can also get OTC medicines with a prescription from your doctor.

• OTC Medicines – English
• OTC Medicines – Spanish

Searchable Formulary

The formulary is a list of all brand-name and generic drugs available in your plan. It lists the drugs found on the PDL and other drugs not found on the PDL. You can use the searchable formulary to search for drugs by:

• Typing the name of the drug in the search box
• Using the A-Z list to search by the first letter of the drug name
• Clicking the therapeutic class of the drug

Searchable Formulary
If you need a drug that isn’t listed on our formulary, you or someone you choose to act for you can request a formulary exception. Just email submitmyexceptionreq@amerigroup.com.

Preapprovals

Some medicines need a preapproval, or an OK, from us before your doctor can prescribe them. Drugs that require preapproval will be listed with PA next to the drug name. For those medicines, your doctor must submit a preapproval request before you can fill your prescription. Your doctor can call Provider Services at 1-800-454-3730 or fax the form to 1-800-964-3627.

Drugs that require preapproval include those that:

• Can have high side effect potential
• Should be prescribed only for specific usage
• Have a high misuse or abuse potential
• May cost more than other preferred drugs

The preapproval process helps us make sure you’re taking medicines safely and correctly.

Other times you may need preapproval are:

• When requesting a higher dosage than recommended
• When the drug is part of a step therapy treatment plan
• When requesting a brand-name drug that already has an FDA-approved generic version

If your doctor recommends a drug that isn’t on our formulary, you may request an exception by emailing us at submitmyexceptionreq@amerigroup.com. You’ll be asked to supply a reason why it should be covered.

Drug Interactions and Side Effects

Learn more about drug interactions or side effects on the Express Scripts Drug Information page.

Member resources

Your member handbook is your go-to-guide for health services. Read it to find out about:

• How to use your benefits
• How to choose a primary care provider
• How to get help if your doctor’s office is closed
• How to reach Amerigroup Member Services if you have questions
• Your rights and responsibilities as an Amerigroup member

Need a handbook mailed to you?

Call Member Services at 1-800-600-4441 (TTY 711).

• Member Handbook – English
• Member Handbook – Spanish

Get the Express
Scripts App

Manage your medicines with ease anytime, anywhere with this free app.

Use the app to:

• Set reminders to take or reorder your meds
• Find a pharmacy near you
• Get your pharmacy history and personal alerts