Pharmacy and prescription drugs
Your benefits include a wide range of prescription drugs. We work with IngenioRx to provide these pharmacy benefits.
Find a pharmacy
To find a pharmacy near you, use our pharmacy locator tool.Find a pharmacy
Fill a prescription
Please bring your member ID and prescription to a plan pharmacy. A doctor can also call in the prescription for you.
It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one medicine. If you use another pharmacy, you should tell the pharmacist about all medicines you or your child are taking.
Have your medicines mailed to you
We make filling your prescriptions as convenient as possible. You can log in to your account and manage your prescriptions filled through home delivery. With your secure online account, you can:
- Order refills
- Track your shipments
- Get notifications
Prescription Drug Home Delivery Form
You can get many prescription drugs shipped directly to your home through IngenioRx Home Delivery. Please use this form to set up home delivery for your prescription.
Prescription Drug Reimbursement Form
If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form.
For medicines purchased before October 1, 2019:
For medicines purchased on or after October 1, 2019:
Copays are a set dollar amount you pay for a covered service, like getting a prescription filled. This is also known as cost sharing — the member shares the cost of some services. Some members have a copay for prescriptions: *
NJ FamilyCare A, B and ABP
You don’t have a copay for prescriptions.
NJ FamilyCare C and D
You pay $5 for brand-name drugs and $1 for generic drugs.
Cost-share limits for NJ FamilyCare C and D members
When you reach your family cost-share limit, you will no longer have to pay a copay for additional services.
*Alaskan Natives and Native American Indians under the age of 19 don’t have copays.
Drug coverage information
Your benefits include a wide range of prescription drugs. Amerigroup also covers many over-the-counter (OTC) medicines for NJ FamilyCare A, B, ABP, and C members.
Preferred Drug List (PDL)
The Preferred Drug List (PDL) is the list of drugs that your doctor will use first when prescribing you medicine. These drugs have been chosen for their quality and effectiveness. Your doctor can prescribe most of these medicines to you without getting preapproval, or an “OK” from us. The PDL is updated frequently.
- Preferred Drug List — English
- Preferred Drug List — Spanish
- Half Tablet Drug Program List — English
- Half Tablet Drug Program List — Spanish
The formulary is a list of all brand-name and generic drugs available in your plan. All drugs on the formulary are covered, but some require preapproval before the prescription can be filled.
Find your medicine
Do you want to look up your medicine and find out if it is covered in your plan? It’s easy when you use our search tool. This tool will help you learn about any limitations or restrictions for any particular drug.
You can search for your drug by:
- Typing the name (at least first three letters) of the drug in the search box.
- Using the A-Z list to search by the first letter of your drug.
- Clicking the therapeutic class of the drug.
Don’t see it listed?
If you don’t see your medicine listed on the drug lists, you may ask for an exception at firstname.lastname@example.org. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc. We can also help if your doctor asked for preapproval for your medicine, but you have questions about medication coverage.
If you don’t hear from us within five business days, please call Member Services at 1-800-600-4441 (TTY 711).
Extra over-the-counter (OTC) medicines benefit
As an Amerigroup member, you can get an extra $15 over-the-counter (OTC) benefit four times a year through our Healthy Rewards program. To sign up for Healthy Rewards, call 1-877-868-2004 (TTY 711) or visit www.myamerigroup.com/HealthyRewards.
Prior authorizations (preapprovals)
Some medicines need a preapproval, or an “OK,” from Amerigroup before your doctor can prescribe them. The preapproval process helps us make sure that you’re taking medications safely and correctly.
Here are some reasons that preapproval may be needed:
- There is a generic or pharmacy alternative drug available
- The drug could be misused or abused
- There are other drugs that should be tried first
- The drug has a high side effect potential
- The drug is prescribed at a higher dosage than recommended
- There is additional information needed about your condition so we can match it to the FDA approval of the drug and/or studies of effectiveness
For medicines that need preapproval, your provider will need to call Provider Services. Amerigroup will review the request and give a decision within 24 hours. If you need your medicine right away, you can get a 72-hour supply while you wait.
If you misplace your medicine or it is stolen, contact your provider. They will work with the pharmacy and Amerigroup to review your case and replace the medicines as needed.
If you have any questions about your pharmacy benefit, you can reach Pharmacy Member Services, 24 hours a day, 7 days a week at 1-833-207-3115 (TTY 711).
Get your specialty medications
If you have a complex or chronic health condition that requires special medicine, we can help. We partner with IngenioRx Specialty Pharmacy and other pharmacies to meet all your specialty medication needs.Learn about specialty pharmacy