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Medicaid and CHIP Pharmacy Benefit Updates Related to the Coronavirus Outbreak

Date: 04/03/20

On March 19, 2020, the Texas State Board of Pharmacy authorized provisions for pharmacists in Texas to provide emergency refills when the prescriber cannot be reached. Specifically, in an emergency, a pharmacist may use his/her professional judgment in refilling a prescription drug order for a drug (other than a Schedule II controlled substance) provided failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering.

On March 20, 2020, The Texas State Board of Pharmacy also provided guidance related to four medications showing promise for COVID-19 treatment. No prescription or medication order for chloroquine, hydroxychloroquine, mefloquine, or azithromycin may be dispensed or distributed unless all the following apply:

The prescription or medication order bears a written diagnosis from the prescriber consistent with the evidence for its use. The prescription or medication order is limited to no more than a fourteen (14) day supply, unless the patient was previously established on the medication prior to the effective date of this rule; and No refills may be permitted unless a new prescription or medication order is furnished.

Superior’s Pharmacy Benefit Manager’s claims processing systems are now set to accommodate early refills. Network pharmacies were provided guidance on how to process early refills by the pharmacy benefit manager (PBM). Superior has for many years offered extended day supplies (90 day supplies) of medications. Medications filled for 90 days are available at mail order and retail pharmacies who accept Superior’s terms and conditions to fill such products. Superior has numerous network pharmacies offering free outpatient pharmaceutical deliveries for Medicaid and CHIP members.

Please note:

  • Superior will not charge a member any fees for choosing to use a mail-order pharmacy, including postage or handling for medication deliveries.
  • Use of a mail-order pharmacy is an option for obtaining medication delivery in addition to filling prescriptions through network-community retail pharmacies, who may also provide delivery services.

The COVID-19 pandemic may impact the medical product supply chain in the U.S., including potential drug shortages. The Texas Vendor Drug Program (VDP) is closely monitoring the U.S. Food & Drug Administration (FDA) website for new drug shortages related to the outbreak. The VDP encourages providers to complete the Drug Shortage Notification (HHS Form 1315) to inform Texas Health and Human Services (HHS) of potential shortages impacting prescribing choice or pharmacy claim processing. This process ensures the VDP has the information regarding any alleged shortages so they may be reviewed for possible formulary alternatives.

As updates continue to quickly emerge on the Coronavirus (COVID-19) outbreak in Texas, Superior would like to ensure the latest pharmacy benefit updates are shared.

For any questions, please contact Superior’s Pharmacy Department at 1-800-218-7453, ext. 22080.

For the latest Superior news on Coronavirus, please visit: SuperiorHealthPlan.com/Providers/Coronavirus.