Pharmacy

You can get unlimited prescriptions with your Medicaid or CHIP coverage when you use a pharmacy in Superior’s network.

Superior’s network pharmacies can help you understand which medications are covered and help you choose an option that works for you. If a medication is not covered, the pharmacy can help find another covered medication.

You can also talk with your doctor or clinic about covered medications and decide together what is best for you.

Texas Medicaid and CHIP formularies are provided by the Texas Vendor Drug Program. Superior is required to implement this formulary list for all Medicaid and CHIP members. All formularies are posted here. Each Managed Care Organization (health plan) in Texas uses the same formulary list provided by the state. The formularies are available in paper form without charge and can be provided to members upon request within five business days.

Accu‑Chek Guide Me is the preferred blood sugar meter for Medicaid and CHIP members. With a prescription from your doctor, you can get an Accu‑Chek Guide Me meter at no cost.

Your Superior network pharmacy can process the meter right at the pharmacy, making it easy for you to get started. Talk with your provider about getting a prescription for the Accu‑Chek Guide Me meter.

Superior covers prescriptions for all members. You can fill your prescriptions at most drug stores in Texas.

Superior’s pharmacy network includes many well‑known stores like CVS (including CVS inside Target), H‑E‑B, Walmart, Randall’s, and Kroger’s along with many others. If you need help finding a pharmacy, you can call Member Services. You can also see a list of network pharmacies using Superior’s Find a Provider tool.

Remember: Always take your Superior Member ID card with you when you go to the doctor or the pharmacy.

Superior has many contracted drug stores that can fill your medications. It is important that you show your Superior Member ID card at the drug store. If the drug store tells you they do not take Superior members, you can call Call Member Services using Superior's Phone Directory. We can help you find a drug store that can fill your medications for you.

If you choose to have the drug store fill your medications and they do not take Superior members, you will have to pay for the medication.

Superior offers many medications by mail. Some Superior pharmacies offer home delivery services. Visit Superior’s Phone Directory webpage to contact Member Services or the Express Scripts (ESI) Pharmacy Member Portal to learn more. You can also call ESI at 1-833-750-4300 (TTY:711).

Call Member Services to learn more about mail order or to find a pharmacy that may offer home delivery service in your area.

It is important to keep your medications in a safe and secure place. If you lose your medications please go to your local pharmacy. The pharmacy will work with Superior and our contracted Pharmacy Benefit Manager (PBM) to help in the review of a replacement.

A prior authorization means your doctor needs to get approval from your health plan first before you can get some medications.

Federal and Texas law help make sure you get your medication when you need it right away. If a medication needs prior authorization and approval is not available yet, the pharmacy can give a 3‑day (72‑hour) emergency supply.

The pharmacist will give this short supply when waiting could cause health problems within the next 3 days, so you don’t have to go without your medication while approval is being worked on.

The Texas Medicaid formulary is available on the Texas Vendor Drug Program (VDP) website. The list is updated regularly and posted by the VDP.

The Texas Medicaid Prior Authorization Criteria is available at the Texas Vendor Drug Program website.

Clinical prior authorization edits are created by the Texas Vendor Drug Program. All clinical edits implemented by Superior can be found here.

A clinical prior authorization edit requires your doctor to obtain approval before a medication is covered. This process helps ensure a medication is medically necessary and safe for the member. The Texas Vendor Drug Program (VDP) establishes the clinical criteria for these edits.

New prescriptions or medication refills may be dispensed up to a maximum 31-day supply or 90-day supply for select medications.

Some medications may have quantity limits which help to make sure they are used safely. It sets how much medication can be covered in a certain time.

Non‑preferred medications are available if a member has tried a preferred medication first, or if the preferred medication is not right for them, such as due to an allergy or other medical reason.

Non‑preferred medications require prior authorization, which means the doctor must get approval before the medication is covered.

Therapeutic interchange means using a different medication that works the same way, even if it is not exactly the same medication. This helps keep costs lower and is only done with your doctor’s approval.

Superior will always cover medications that are preferred by the Texas Vendor Drug Program. Superior may talk with your doctor about the formulary and other medication options that are available for you.

Any change to your medication will be made with your doctor’s guidance, to make sure it is safe and right for you.

The Texas Vendor Drug Program has limited home health supplies available through the pharmacy. That list includes items like insulin syringes and test strips. You may get those at a local network pharmacy with a prescription. You may also get covered Durable Medical Equipment (DME) or Medical Supplies through a Superior provider. To request a prior authorization from the Superior DME Prior Authorization Department, call 1-800-218-7508 ext. 53227.

For Medicaid, the contact information is:

Superior HealthPlan
Attn: Appeals Department
PO Box 31398
Tampa, FL 33631-3398

Phone: 1-833-236-9334
Fax: 1-888-865-6531

This is for Medicaid and CHIP members who need prior authorization when the prescriber cannot be reached or the request is pending and the medication is necessary for the patient’s health and safety. Drug stores may provide a 3-day supply of medication for prescriptions that need prior authorization. The local pharmacy should try to notify the provider’s office to request prior authorization or for a change to a drug on the Preferred Drug List (PDL).

There are exceptions:

• The local pharmacist may deny the 72-hour supply if he/she determines the medication is not appropriate or safe for the member.
• When medications are NOT covered through the Vendor Drug Program formulary.
• When the prior authorization has been reviewed and previously denied.

It’s important to Superior that our members get the right prescription drug coverage and drug therapy. If you have questions please call Member Services using Superior’s Phone Directory.

The Texas Office of Inspector General (OIG) Lock-In Program restricts Medicaid members to one designated pharmacy if they are identified as using excessive, or unsafe amounts of controlled substance prescriptions.  The lock-in program lasts a minimum of 36 months.

In the event you need a mediccation that your lock-in pharmacy does not have, your lock-in pharmacy is closed, you are currently not near your lock-in pharmacy, or need any other assistance getting your medication, please contact Superior by calling the Member Services number located on the back of your ID card. A dedicated member of our team will review your request and provide assistance.