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 (PA), a few agents will require you to contact our Pharmacy Department for authorization. You can reach our Pharmacy department at 1-800-454-3730 between 8:00 a.m. and 8:00 p.m. Eastern time Monday through Friday and 10:00 a.m. to 2:00 p.m. Eastern time on Saturday. You can also fax your PA request to our Pharmacy department:
- New York: For all HealthPlus Amerigroup members: 1‐800‐359‐5781
- Kansas: 1-800-601-4829 for Retail Prior Authorization and 1-855-363-0728 for Medical Injectables
- Texas: 1-800-601-4829 for Retail Prior Authorization and 1-800-359-5781 for Medical Injectables
- All other states: 1‐800‐359‐5781
Please refer to the formulary when prescribing for Amerigroup Medicare members. Though most medications on the formulary are covered without Prior Authorization (PA), a few agents will require you to obtain an authorization. For Amerivantage 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 through Friday. For Amerivantage Part D, contact Express Scripts Provider Services at 1-800-338-6180 24 hours a day, 7 days a week. The prior authorization form can be found on the left side of this page.
Medicare Part D Rx Coverage Determinations and Appeals
Providers can send a request for a prescription coverage determination or an appeal for a Medicare plan via email rather than fax or phone by sending the request to the following address: email@example.com
Express Scripts, Inc. is a separate company that provides pharmacy services and pharmacy benefit management services on behalf of health plan members.