Georgia Inter-Pregnancy Care Formulary
The medications included in the formulary are reviewed and approved by the 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, step therapy or Center for Medicare and Medicaid Services (CMS) coverage requirements. Medications listed as non-preferred are subject to prior authorization.
Medicines covered under the Interpregnancy Care service level may include:
- Contraceptives
- Prescription drugs, supplies or devices related to a chronic disease or condition that may have caused your baby to have very low birth weight
- Prescription drugs for treatment of sexually transmitted infections except HIV/AIDS and hepatitis
- Multivitamins with folic acid or folic acid vitamin
- Substance abuse treatment
Any medication not related to your Planning for Healthy Babies® benefit will not be covered and prior authorization is not allowed.
Additionally, if a medication is available as a generic formulation, this will be the preferred agent, unless otherwise noted. If you have any questions about coverage of a certain product, please contact us at 1-800-454-3730.
Machine Readable Data for Prescription Drug Formulary: Georgia Inter-Pregnancy Care Medicaid Machine Readable File