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Amerigroup pac formulary

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Medicaid formulary, drug criteria and limitations. Prior authorization forms. Prior authorization lookup tool. Preferred Drug List (PDL) - English; Preferred Drug List (PDL) - Spanish; State Hepatitis C Clinical Criteria; State Hepatitis C Sample Treatment Plan; State Opioid Prescribing Guidance and Policy (Resource) State Opioid Prescribing. WebAmerigroup will pay up to $15 for each member every quarter for certain over-the-counter . WebAfter the total drug costs paid by you and the plan reach $4,, up to the out-of-pocket threshold of $6, For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.