The Apple Health Single Preferred Drug List (PDL) is a list of all brand-name and generic drugs available on the plan. The Health Care Authority (HCA) implemented the Apple Health Single PDL on January 1, 2018. All managed care plans and the fee-for-service program serving Apple Health clients use this PDL. To see what drugs are preferred and whether they need a prior authorization (PA), please go to the Apple Health Single PDL website.
Amerigroup manages medications and supplies that are not part of the Apple Health Single PDL, listed in the above section. For medications that are not included in the Apple Health Single PDL, such as diabetic supplies, spacers and vaccines, please search the Amerigroup PDL.
We post a formulary change notice on our website quarterly to notify of all formulary changes.
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 initiate a new PA request by fax or phone; please note the following contact numbers and PA form below:
Members can fill a 90-day supply of maintenance medications at retail pharmacies. Members can refill their prescriptions every 81 days for a 90-day supply of maintenance medications or every 27 days for a 30-day supply.
A seven-day emergency supply of medications is covered to prevent interruptions in therapy during an emergency, such as a natural disaster.
Emergency fill also means that the dispensing pharmacist used their professional judgment to meet a member’s urgent medical needs. If the dispensing pharmacist determines the member has an urgent medical need, they can:
If a prescribed drug is not listed on the PDL, contact Amerigroup. You may be able to receive it through the Exception to the Rule (ETR) process. You can request Amerigroup to cover it under the ETR process. Please FAX your request to 1-855-292-3370.
To submit a pharmacy paper claim, please complete the Prescription Reimbursement Claim Form and mail it to the address listed on the form or fax it in to the fax number listed on the form for processing.
Find a pharmacy in the network using the pharmacy search tool:
We offer home delivery through IngenioRx Mail Order Pharmacy as an option for members to fill up to a 90-day supply of their maintenance medications. Members can download and print the physician fax form from the website of our pharmacy benefits manager, with the new prescription for a 90-day supply. When you write the new prescription, you can fax or e-fax the form and prescription to the number on the form. We'll take it from there.
*CoverMyMeds is an independent company providing pharmacy benefit management services on behalf of Amerigroup Washington, Inc.
IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Amerigroup Washington, Inc.