Pharmacy and prescription drug benefits

Express Scripts

Your benefits include a wide range of prescription and over-the-counter (OTC) drugs. We work with Express Scripts (ESI) to provide these benefits.

Visit Express Scripts to:

Express Scripts Forms

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.

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

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.