Choice Change Period is from July 1st through September 30th 2017 Preferred Drug List . Preferred Drug List (PDF) Use the Formulary Search Tool through Express Scripts for real-time coverage information; Monthly Formulary Updates (PDF) Georgia Medicaid/PeachCare Preferred Drug List Effective December 1, 2019 clindamycin in D5W injection generic P clindamycin in NaCl 0.9% injection generic P clindamycin injection 150MG/ML (900MG/6ML) generic P DIFICID NP PA QLL DORYX, -MPC NP PA QLL doxycycline hyclate generic P doxycycline hyclate delayed release tabs NP PA QLL UnitedHealthcare Community Plan is pleased to provide this Preferred Drug List (PDL) to be used when prescribing for patients covered by the pharmacy benefit plan offered by UnitedHealthcare Community Plan. Please consider a drug from the generic prescription drug list if it meets your patient’s medical needs. Healthy Living. You may search the Formulary in several ways: • Use the alphabetical list to search by the first letter of your medication. 2020 Preferred Drug List; 2019 Preferred Drug List; 2018 Preferred Drug List; 2017 Preferred Drug List; 2016 Preferred Drug List; Prior Authorization Process and Criteria; Drug Utilization Review Board. Preferred Drug Lists. Georgia Families® Quick Reference Guide: PHARMACY Georgia Families® 2017 New Plan Year This year, open enrollment for the new plan year was from March 1st through March 31st 2017 for ALL Georgia Families® members. WellCare of Georgia Comprehensive Preferred Drug List (List of Covered Drugs) WellCare of Georgia Families Please read: This document tells about the drugs we cover in this plan. Until implementation, providers should continue to access the clinical criteria for medications covered under the medical benefit through the standard process. Welcome to the Maryland HealthChoice Amerigroup formulary guide on Formulary Navigator™ ... Amerigroup Pharmacy Department (prior authorization): 1-800-454-3730 . lidocaine jelly, gel QL lidocaine sol . Peach State Health Plan works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. PDL_December_1_2019.pdf. P4HB Pharmacy Documents and Forms WellCare of Georgia Interpregnancy Care Preferred Drug List (PDL) Update - Effective 11/26/2019 This is a list of changes to our preferred drug list. lidocaine/pramoxine crm (without applicator) QL PA lidocaine topical patch . The Affordable Care Act (ACA) Preventive Drug List consists of medications that may be covered at $0. DO: Dose Optimization Program . Call Avesis Member Services at 1-800-828-9341 for help finding an Amerigroup network eye doctor in your area. Amerigroup members in Georgia receive routine vision services through Avesis Vision. NC Medicaid and Health Choice Preferred Drug List (PDL) effective Dec. 1, 2019 Version Date: 8/1/2017 WEBMBLA-0003-17 Applies to the Louisiana Medicaid market . Brand name drug: Uppercase in bold type . In each class, drugs are listed alphabetically by either brand name or generic name. Amerigroup is a health insurance plan that serves people who get Medicaid. In each class, drugs are listed alphabetically by either brand name or generic name. Legend . Generic drug: Lowercase in plain type . *The co-payment amounts below are for the following services: Oral Maxillofacial Surgery, Pharmacy – Non-Preferred Drugs, Physician Assistant Services, Physician Services (Doctor’s office visits), Podiatry and … Please refer to your plan documents to confirm if the ACA Preventive Drug List applies to you. Before sharing sensitive or personal information, make sure you’re on an official state website. If you have questions or feedback, please email Unless otherwise indicated, authorization criteria is that the client must have tried and failed, or is intolerant to, a designated number of preferred drugs within the drug class unless contraindicated or … QL lidocaine crm/HC . Providers, please visit our website for updates to the prefer red drug list: These policies were developed, revised or reviewed to support clinical coding edits. Fax the completed form to the Priority Partners Pharmacy Department at 1-410-424-4607. Legend . The approved drug list includes generic prescription drugs and some brand-name drugs. PCP, Specialist, Hospital, Facility, Laboratory They are not subject to any annual deductibles, coinsurance, or copayments. Provider directories and drug formularies . ... PSHP GA 2019 Q3 PDL Update (effective 9/23/2019) (PDF). Please note, the Formulary is not meant to be a complete list of the drugs covered under your prescription beneft. Effective dates will be reflected in the Use our Preferred Drug List (PDL) to find more information on the drugs that are covered. Formulary Introduction . Searchable drug formulary Preferred Drug List Effective February 1, 2021. AL: Age Limit Restrictions . Generic drug: Lowercase in plain type . Prior Auth Criteria Search. • With the exception of the “Branded Drugs Classified as Generics” list, TennCare is a mandatory generic program in accordance with state law (TCA 53 -10-205). Amerigroup Washington, Inc. AL: Age Limit Restrictions . The medications included in the Amerigroup formulary are reviewed and approved by the Pharmacy and Therapeutics Committee, which includes Practitioners and Pharmacists from the Provider community. Please select a drug from the list below to see all coverage details regarding the medication. FORMULARY . To see what drugs are preferred and whether they need a prior authorization (PA), please go to the Apple Health Single PDL website. Preferred Drug List Effective February 1, 2021. We also serve individuals who are Medicare-eligible. The Preferred Drug List (PDL) is the list of drugs covered by Peach State Health Plan. State of Georgia government websites and email systems use “” or “” at the end of the address. PSHP GA 2019 Q2 PDL Update (effective 06/24/2019) (PDF) Florida Medicaid Preferred Drug List (PDL) ... Amerigroup 2016 Drug Formulary; Amerigroup 2016 Drug Formulary; Amerigroup 2016 In Texas;... Medicaid Pharmaceutical & Therapeutics Committee Medical Policies applicable to Amerigroup Community Care. We are making health care simpler for individuals served by Medicaid, State Children’s Health Insurance Program and other State-sponsored health programs. oncology drug clinical criteria will not