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Pharmacy Guide: PA Requirements, Formularies and Quantity Limits

Date: 12/16/24

Superior HealthPlan’s Pharmacy Department is responsible for maintaining the list of covered medications 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. For more information and resources, please visit Superior’s Pharmacy webpage.

If you have questions about prior authorizations, appeals, or medications please call Superior’s Pharmacy team:

  • Express Scripts Pharmacy Help Desk
  • Pharmacy Benefit Prior Authorization Requests
    • Phone:
    • Fax:
      • 1-800-977-4170 (Ambetter)
      • 1-877-423-2523 (Medicaid and CHIP)
  • Clinician Administered Drug/Med Pharm/Biopharmacy Prior Authorization Requests
    • Phone:
    • Fax:
      • 1-886-562-8989 (Ambetter)
      • 1-866-683-5631 (Medicaid and CHIP)
  • Appeal Requests
    • Phone:
    • Fax:
      • 1-866-918-2266 (Ambetter)
      • 1-866-918-2266 (Medicaid and CHIP)

For information about Wellcare By Allwell pharmacy benefits, please visit the Pharmacy Benefits section on the Wellcare By Allwell website.