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
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
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