Pharmacy and prescription drugs

Fill a prescription

Bring your member ID card and prescription to a plan pharmacy. A doctor can also send 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 prescription. If you use another pharmacy, you should tell the pharmacist about all medicines you are taking.

Have your medicines mailed to you

We make getting your prescriptions filled 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 Walmart Home Delivery. Use this form to set up home delivery on your prescription.

• Prescription Drug Home Delivery Form – English
• Prescription Drug Home Delivery Form – Spanish

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.

• CarelonRx Reimbursement Form – English
• CarelonRx Reimbursement Form – Spanish

Medications straight to your doorstep

With the ZipDrug pharmacy program, you’ll get customized care at no extra cost. ZipDrug will connect you with a participating local pharmacy. The pharmacy will package your medications by time and day to help you understand what to take and when. They’ll also schedule free hand-delivery. You may even qualify for one-on-one support from the local pharmacy. They’ll create a personalized care plan to help manage your medications and health conditions.

Here’s how it works:

1. Call to enroll at 844-947-3784 Monday through Friday, 8 a.m. to 4:30 p.m. Central Time.
2. Your prescriptions will be transferred by your participating local pharmacy. They’ll package your medications by time and dayand set up refills so they’re on the same schedule.
3. Receive your prescriptions by scheduled hand-delivery, at no extra cost. When your prescriptions are ready, the pharmacy will call you to schedule delivery for a day and time that’s most convenient.

Your costs

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 CHIP members have pharmacy copays.

STAR, STAR Kids, and STAR+PLUS members

You don’t have pharmacy copays. If you have both Medicare and Medicaid, contact your Medicare Part D plan to learn more about your pharmacy benefits.

CHIP members

There may be copays for your prescriptions. Check your member handbook or your member ID card for copay amounts.

CHIP Perinate members

You don’t have pharmacy copays.

Drug coverage information

Texas Vendor Drug Program (VDP) Formulary

Your or your child’s doctor chooses drugs from the Texas Vendor Drug Program (VDP) formulary. The formulary is a list of all brand-name and generic drugs available in your plan. You can use the searchable formulary to search for drugs by name or type (class).

Some medicines need a preapproval, or an OK, from us before your doctor can prescribe them. For these medicines, your doctor must submit a preapproval request before you can fill your prescription.

When there is a generic drug available on the VDP list, it will usually be covered in place of the brand-name drug. Generic drugs are equal to brand-name drugs as approved by the Food and Drug Administration (FDA). If your prescription says you need the brand-name drug, we will cover the brand-name drug instead of giving you a generic.

Amerigroup uses Texas Vendor Drug Program (VDP) Prior Authorization criteria. The criteria is posted here.

Each individual policy includes a list of drugs to which each clinical policy applies.

VDP publishes a chart that shows which Prior Authorization policies each Managed Care Organization has opted into. The chart is posted here.

Don’t see it listed?

If you don’t see your medicine listed in the formulary, you may ask for an exception at submitmyexceptionreq@amerigroup.com. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc.

You can call Member Services to have a hard copy of the formulary mailed to you at no cost.

Preferred Drug List (PDL)

For Medicaid members, the Preferred Drug List (PDL) shows which drugs the VDP recommends that your doctor try first.

Prior authorizations (preapprovals)

Some medicines need a preapproval, or an OK from Amerigroup, before your provider 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 1-800-454-3730. Amerigroup will review the request and give a decision within 24 hours. If you need your medicine right away, you may be able to get a 72-hour supply while you wait. The messaging sent to the pharmacy includes directions for submitting a 72-hour supply request. If additional assistance is needed, pharmacies may contact the CarelonRx Help Desk at 833-252-0329.

You can learn more about the prior authorizations (preapprovals) process on the Amerigroup provider website.

Need help?

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, call Pharmacy Member Services 24 hours a day, 7 days a week at 1-833-235-2022 (TTY 711). STAR Kids members, call 1-833-370-7463 (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 CarelonRx Specialty Pharmacy and other pharmacies to meet all your specialty medication needs.