Provider Pharmacy Prior Authorization Forms are located on the Provider Resources Forms page, under Prior Authorization Forms.
Superior HealthPlan is committed to providing appropriate, high-quality and cost-effective drug therapy to all members. Superior covers prescription medications as outlined by the Texas Medicaid and CHIP Vendor Drug Program (VDP). Some medications may require prior authorization, and may have clinical prior authorization edits or other limitations consistent with FDA recommendation for safe and effective use. Other medically necessary pharmacy services or products are covered as well and consistent with the Vendor Drug Program.
Pharmacies wishing to be contracted as a provider are required to be a Medicaid provider and be contracted with Superior’s Pharmacy Benefit Manager (PBM). Pharmacies should contact the contracted PBM and the Vendor Drug Program directly for contracting assistance.
For prior authorization of medications covered by the VDP, contact the contracted PBM at 1-800-460-8988.
For information regarding contracting as a network pharmacy, please visit the Envolve Pharmacy website.
To access the Texas Medicaid/CHIP Vendor Drug Program (VDP), including the Medicaid formulary and Preferred Drug List (PDL), visit the Texas Vendor Drug website.
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To locate Ambetter from Superior HealthPlan Pharmacy Resources, please visit Ambetter's Pharmacy webpage.
Medicaid/CHIP Pharmacy Help Desk
Toll Free: 1-866-768-0468
Prior Auth Requests
Medicare Pharmacy Help Desk
Toll Free: 1-877-935-8021
Prior Auth Requests
Clinician Administered Drugs
Phone: 1-800-218-7453 ext. 22272
Out-Patient Rx (PBM: Envolve Pharmacy Solutions)
Resolution Help Desk: 1-800-460-8988
Prior Auth Requests Phone: 1-866-399-0928
Prior Auth Requests Fax: 1-866-399-0929
Appeal Requests (Superior Prior Authorization Department)
Toll Free: 1-877-398-9461 ext. 22168