Amerigroup Pharmacy and Prescription Drugs Program
Amerigroup manages your pharmacy benefits
Your pharmacy benefits are provided by Amerigroup. We have contracted with Caremark to administer these benefits.
Managed Care Organizations (MCOs) that contract with the Health and Human Services Commission administer prescription drug benefits and payments for Medicaid managed care and Children's Health Insurance Program (CHIP) clients. Each MCO contracts with a pharmacy benefits manager that processes prescription claims and contracts and works with pharmacies that serve CHIP and Medicaid managed care clients.
Resources available for pharmacies at txvendordrug.com include:
The Pharmacy Assistance chart will provide pharmacy providers with required fields to bill plan (such as BIN and PCN numbers), as ell as pho e u e s fo ea h pla ’s pha a y illi g call center, prior
authorization call center, and client call center
The Provider Enrollment chart provides the name of each plan and a phone number for pharmacy providers to contact that wish to contract with that plan
A table is provided of all MCO/PBM entities by county and service area
Our pharmacy notification letter, which includes information about how to verify eligibility and who to contact if billing issues arise
Amerigroup pharmacy and prescription drugs program
Amerigroup pharmacy benefits cover a wide range of prescription and Over-The-Counter (OTC) medicines. More than 50,000 pharmacies across the country participate with Amerigroup. Pharmacies must be contracted with the Texas Vendor Drug Program (VDP) to be network pharmacies.
Pharmacy benefits in Texas are provided through Caremark.
Caremark Pharmacy Search
Or call our Member Services (7 days a week from 8 a.m. to 8 p.m. Central time)
OMedicaid Members: 1-800-600-4441
(TTY 1-800-855-2880)
OMedicare Members: 1-866-805-4589
(TTY 1-800-855-2880)
We even offer specialty pharmacy services for hard-to-find medicines which can be mailed either directly to your house or doctor's office when necessary.
Drug coverage information
Amerigroup uses the State Vendor Drug Program (VDP) list of drugs for your doctor can to choose from. It includes all medicines covered by Medicaid and CHIP.
View our Texas Drug List
Your doctor may need to get approval from us for certain drugs. This is known as prior authorization. Your
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get approval from us before you can get your prescription filled for these drugs. When there is a generic drug available, it will be covered if it is on the VDP formulary. Generic drugs are equal to brand-name drugs as approved by the Food and Drug Administration (FDA).
Getting your prescription filled is easy!
Simply present the written prescription from your doctor to a participating network pharmacy. Or your doctor can call in the prescription to your local participating pharmacy. You will also need to show the pharmacy your Amerigroup ID card to have a prescription filled. It is good to use the same pharmacy each time. This way, your pharmacist will know about problems that may occur when you are taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about any medicines you are taking.
Frequently asked questions
Click on a question to see our answer:
What pharmacies are in the Amerigroup network?
How do I transfer my prescriptions to a network pharmacy?
How does my provider request prior authorization?
What if a copay is required and I am unable to pay it?
How do I get my medicines if I am traveling?
What happens if my medicines are lost or stolen?
What if I paid out of pocket for a medicine and want to be reimbursed?
What pharmacies are in the Amerigroup network?
There are many chain and local pharmacies for you to choose from in the Amerigroup network. You can find a list in your new member enrollment package. Or click on Find a Doctor. You can also call Member Services at 1-800-600-4441 (TTY 1-800-855-2880).
How do I transfer my prescriptions to a network pharmacy?
If you need to transfer your prescriptions, all you need to do is:
Call the nearest network pharmacy and give the needed information to the pharmacist Bring your prescription container to the new pharmacy and they will handle the rest
How does my provider request prior authorization?
Your doctor can request prior authorization on medicines:
Fax completed prior authorization forms to 1-800-359-5781
Call the Amerigroup Pharmacy department at 1-877-440-3621
What if a copay is required and I am unable to pay it?*
If you ha e CHIP a d you do ’t ha e the opay fo you edi i e, you pha a y should still p o ide the
medicine. If the pharmacy allows you to take the medicine without paying the required copay, you will have to pay the copay at a later time.
*Medicaid members, CHIP Perinate members, and CHIP Perinate newborns do not have copays.
How do I get my medicine if I am traveling?
Amerigroup has network pharmacies in all 50 states. If you need a refill while on vacation, call your doctor for a new prescription to take with you.
What happens if my medicines are lost or stolen?
If your medicines are lost or stolen, you should contact your doctor to authorize the pharmacy to refill your prescription early. The pharmacy may have to contact the Prior Authorization Desk for prior approval. Replacement of lost or stolen medicines will be reviewed on a case-by-case basis.
What if I paid out of pocket for a medicine and want to be reimbursed?
If you had to pay for a medicine, you may submit a request for reimbursement. You’ll eed to ail the completed Reimbursement Request Form along with any receipts to:
Amerigroup
Pharmacy Department
PO Box 62509
Virginia Beach, VA 23466-2509