Prior Authorization | Providers – Amerigroup

Medicaid and Medicare Part B

Click the Health Plan location to download the required Prior Authorization Request Form.

Florida
Georgia
Louisiana

Maryland
Nevada
New Jersey

New York
Texas
Washington

Florida Psychotropic Medication Guidelines for Children Younger than 13

Louisiana Synagis Enrollment Form

Medicare Part D

Contact Express Scripts Provider Services at 1-800-338-6180 or use the Provider Portal located here