Pharmacy Guide: Authorization Requirements, Formularies and Quantity Limits

Date: 09/15/22

Superior HealthPlan’s Pharmacy department is responsible for maintaining the list of covered medication under the pharmacy benefit and ensuring they are medically necessary and meet professionally recognized standards of pharmaceutical care. Some medications may require non-preferred prior authorizations, clinical prior authorization edits or other limitations (ex: quantity limits) consistent with Food and Drug Administration (FDA) recommendations for safe and effective use.

Superior Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP) and Ambetter from Superior HealthPlan (Marketplace) programs each follow their own medication formularies, as well as their own prior authorization and appeals processes.

Superior has created helpful guides for physicians and pharmacies, to help them understand formularies, prior authorization and appeals process, and pharmacy processing information for all products. Please download the reference guides below for more information:  

• Pharmacy Processing Information for Physicians (PDF)
• Pharmacy Processing Information for Pharmacies (PDF)

For questions, please contact Superior’s Pharmacy department at:

• 1-800-218-7453, ext. 22080 (STAR, CHIP, Ambetter)
• 1-800-218-7453, ext. 22272 (STAR+PLUS, STAR Health, STAR Kids)
• 1-800-218-7453, ext. 54019 (STAR+PLUS Medicare-Medicaid Plan [MMP])