Pharmacy Processing Quick Reference Guides
Date: 10/07/20
Superior HealthPlan’s Pharmacy department is responsible for maintaining the list of covered medications under the pharmacy benefit, ensuring they are medically necessary and meet professionally recognized standards of pharmaceutical care. Some medications may require prior authorizations, clinical prior authorization edits or other limitations consistent with Food and Drug Administration (FDA) recommendations for safe and effective use.
Allwell from Superior HealthPlan (Medicare) (HMO and HMO SNP), Ambetter from Superior HealthPlan (Marketplace), Medicaid-Medicare Plan (MMP), Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP programs each follow their own medication formularies, as well as their own prior authorization and appeals processes.
Superior has created detailed guides for physicians and pharmacies, to help provide clarification on formularies, prior authorization, the 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 (Allwell, STAR+PLUS, STAR Health, STAR Kids)