Pharmacy Information

Pharmacy information for providers including contact information and formulary details can be found below. Pharmacy benefits are provided through CarelonRx.

Medicaid Preferred Drug List (Formulary)

Please refer to the Amerigroup Community Care Preferred Drug List (PDL) when prescribing for our members. The formulary contains preferred and non-preferred drugs listed by brand or generic name.  Non-preferred drugs are subject to prior authorization. Some drugs on the PDL may have additional requirements or limitations of coverage that will require you to contact our Pharmacy PA Center for authorization.

Drugs not listed in the formulary are considered to be non-formulary until they are reviewed for formulary placement through the P&T process.  These new drugs may be available through prior authorization or medical necessity review.  Providers may request the addition of a product to the formulary by submitting their personal request along with any supporting information using this link: Drug List Addition Request (carelonrx.com)

The PDL is reviewed and updated quarterly.  The PDL can be accessed from the links below.

 

Prior Authorization Requests

Some drugs, drug combinations, and drug doses require prior authorization (PA). To submit electronic prior authorization (ePA) requests, use CoverMyMeds . Creating an account is free.

While ePA helps streamline the PA process, you may also initiate a new PA request by calling or faxing a completed Pharmacy Prior Authorization form to Amerigroup. Please note the following contact numbers for prior authorization requests and PA form below:

Amerigroup Pharmacy PA Center

Hours: Monday – Friday 7:00 a.m. – 11:00 p.m.; Saturday – Sunday 8:00 a.m. – 6:00pm

Phone:

1-800-454-3730

Prior Authorization for Retail Pharmacy/Prescription Drugs Fax:

1-844-490-4736

Prior Authorization for Medical Injectables Fax:

1-844-490-4870

Specialty Drugs

Specialty drugs may be covered as a pharmacy benefit or an outpatient medical benefit. Providers should refer to our searchable formulary for pharmacy benefit drugs and the Prior Authorization Lookup Tool for medical benefit drugs to determine if a prior authorization is needed.

Once the PA has been submitted and approved, providers should send the prescription to one of the following in-network specialty pharmacies:
 

CarelonRx Specialty Pharmacy

Handles specialty drugs given as a pharmacy benefit.

Phone:

1-833-255-0646

Fax:

1-833-263-2871

CVS CareMark Specialty Pharmacy

Handles specialty drugs covered as a medical benefit.

Phone:

1-877-254-0015

Fax:

1-866-336-8479

As of September 1, 2021, Twelvestone Pharmacy also handles specialty drugs under the pharmacy benefit. Providers should call 844-893-0012 or fax 800-223-4063 to submit prescriptions.

CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Amerigroup Community Care. CVS is an independent company providing pharmacy services on behalf of Amerigroup Community Care.

Find a Pharmacy

Find an in-network pharmacy using the pharmacy search tool:

Find a Pharmacy

Related resources

 

Provider tools & resources

Interested in becoming a provider in the Amerigroup network?

We look forward to working with you to provide quality services to our members.