Pharmacy information and tools
Amerigroup Community Care will administer pharmacy benefits for enrolled members. CarelonRx* is the pharmacy benefits manager.
Medicaid
Please refer to the Preferred Drug List (PDL) when prescribing for our members. This guide does not contain a complete list of drugs; rather, it lists the preferred drugs within the most commonly prescribed therapeutic categories.
Though most medications on the PDL are covered without prior authorization, a few agents will require you to contact our Pharmacy Department for authorization.
Prior authorizations by phone:
You can reach our Pharmacy Department at 1-800-454-3730 from 8:00 a.m. to 8:00 p.m. Eastern time Monday to Friday and 10:00 a.m. to 2:00 p.m. Eastern time on Saturday.
Pharmacy Department:
1-800-454-3730
Prior authorizations by fax:
You can also fax your request to our Pharmacy department:
Retail prior authorization:
1-844-509-9863
Medical injectables:
1-844-509-9865
Medicare
Please refer to the formulary when prescribing for Medicare members. Though most medications on the formulary are covered without prior authorization, a few agents will require you to obtain an authorization. For Medicare Part B, contact Provider Services department 1-866-805-4589 Option 5, from 8:00 a.m. to 8:00 p.m. local time, Monday to Friday.
For Medicare Part D, contact:
CarelonRx Provider Services at:
1-833-293-0659
Medicare Part D Rx coverage determinations and appeals
Providers can send a request for a prescription coverage determination for a Medicare plan via electronic prior authorization (ePA) rather than fax or phone by submitting the request from one of the following ePA websites:
Hot Tips:
Pharmacy Hot Tips are brief messages that provide information on preferred formulary products used to treat common diseases and conditions such as asthma and diabetes.
If you would like additional pharmacy information to assist our members, contact your Provider Relations representative, and we will prepare a pharmacy Hot Tip for you!
Documents
- Hot Tip: Acne
- Hot Tip: ADHD
- Hot Tip: Allergies
- Hot Tip: Asthma (Adults)
- Hot Tip: Asthma (Pediatric)
- Hot Tip: Atypical Antipsychotics
- Hot Tip: Chronic Pain
- Hot Tip: Diabetes
- Hot Tip: Opioid Use Disorder
- Hot Tip: Proton Pump Inhibitors (Adult)
- Hot Tip: Proton Pump Inhibitors (Pediatric)
- Hot Tip: Topical Corticosteroids
Related information
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization lookup tool
- Prior Authorization requirements
- Claims overview
- Member eligibility & pharmacy overview
- Provider manual and guides
- Referrals
- Forms
- Training Academy
- Pharmacy information
- Electronic Data Interchange (EDI)