Effective August 1, 2025: Pharmacy and Biopharmacy Policies

Date: 05/21/25

Superior HealthPlan has added, updated or retired certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on August 1, 2025, at 12:00AM.

Policy	Applicable Products	New Policy Overview or Updated Policy Revisions
No Coverage Criteria, Recent Label Changes Pending Clinical Policy Update (CP.PMN.255 )	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), and CHIP	Policy updates include: Added clarification for non-preferred PDL drugs that requires failure of two preferred PDL drugs.
Brand Name Override and Non-Formulary Medications (HIM.PA.103)	Ambetter	Policy updates include: Clarified for brand name drug requests, member must use generic or all preferred biosimilar(s), if available.

To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.

Prior to updates, pharmacy and biopharmacy clinical policies are reviewed and approved by the Pharmacy and Therapeutics (P&T) Committee.

For questions or additional information, please contact Superior’s Pharmacy Department at 1-800-218-7453, ext. 22272.