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Effective September 1, 2026: Pharmacy and Biopharmacy Policies

Date: 06/30/26

Effective on September 1, 2026, at 12:00AM, Ambetter from Superior HealthPlan, Ambetter Health Solutions (ICHRA) and Superior HealthPlan (Medicaid) have 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.

The links above:

  • May not all be applicable to Ambetter from Superior HealthPlan, Ambetter Health Solutions (ICHRA) and Superior HealthPlan (Medicaid). To see which policies are applicable, please see policies on the Superior’s Clinical, Payment & Pharmacy Policies webpage.
  • Are updated monthly and cannot be referenced after October 1, 2026.

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.