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Amerigroup Washington, Inc.

The medications included in the Amerigroup formulary are reviewed and approved by the Amerigroup Pharmacy and Therapeutics Committee, which includes Practitioners and Pharmacists from the Amerigroup Provider community.

Please select a drug from the list below to see all coverage details regarding the medication. Some medications listed may have additional requirements or limitations of coverage. These requirements and limits may include prior authorization, quantity limits, age limits or step therapy.

Medications not listed on the formulary are considered to be non-formulary and are subject to prior authorization.

Additionally, if a medication is available as a generic formulation, this will be Amerigroup's preferred agent, unless otherwise noted. If you have any questions about coverage of a certain product, please contact us at 800-454-3730.

Amerigroup will follow the Washington Health Care Authority (HCA) PDL for coverage of Atypical Antipsychotics.  All members UNDER 18 must utilize state UM's. Children less than 18 years of age that exceed clinically established age/dosing limitations for these medications will require a referral to Second Opinion Network (SON).

Machine Readable Data for Prescription Drug Formulary: Washington Medicaid Machine Readable File

The WA HCA PDL can be located at http://www.hca.wa.gov

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Formulary Id: 00000000
Formulary Effective Date: 11/01/2019

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