Preferred Drug List - Amerigroup

Preferred drug ListVersion Date: 2/1/2018 WEBMGA-0242-17 Applies to Medicaid market- Georgia KEY: *age restrictions applyPA requires prior authorization ST requires trial of first step product QL daily dosage limits apply RX legend prescription product OTC over-the-counter available by prescription ANTIBACTERIALS ANTIBIOTICS CEPHALOSPORINS First Generation QL cefadroxil QL cephalexin Second Generation QL cefaclor QL cefprozil QL cefuroxime axetil Third Generation QL cefdinir QL cefpodoxime FLUOROQUINOLONES QL* ciprofloxacin tabs *ofloxacinMACROLIDES QL azithromycin QL clarithromycin QL erythromycin (all salt forms)

Preferred Drug List Version Date: 2/1/2018 WEBMGA-0242-17 Applies to Medicaid market- Georgia KEY: * age restrictions apply. PA requires prior

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