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 Pharmacy Services 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.
Pharmacy providers can download or view/search a Maximum Allowable Cost (MAC) list by visiting the CVS Pharmacy Portal.
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- Clinical Prior Authorization
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- CoverMyMeds: Prescription Drug Prior Authorization (PDF)
- Diabetic Meter Program: OneTouch Meter Flyer (PDF) – Effective 10/1/22, OneTouch Verio is the preferred brand for Medicaid and CHIP Products.
- Medicaid Electronic Formulary and PDL
- Prescription Monitoring Program (PMP) Reference Guide (PDF)
- Pharmacy Processing Information for Physicians (PDF)
- Pharmacy Processing Information for Pharmacies (PDF)
- Proton Pump Inhibitors (PPIs): Use and Risks in Adults (PDF)
- Proton Pump Inhibitors (PPIs): Use and Risks in Pediatrics (PDF)
- Pharmacy Resource Guide and Benefits Overview (PDF)
- Preferred Insulin Pen Needle Program for Medicaid (PDF)
- Quantity Limits (PDF)
- Superior HealthPlan's Opioid Toolkit
- Superior HealthPlan STAR+PLUS MMP List of Covered Drugs (Formulary)
- Texas Vendor Drug Program Formulary and PDL
- TMF Network - Medication Safety in Nursing Homes (PDF)
- Use of High-Risk Medications in the Elderly (DAE) (PDF)
- VDP: Pharmacy Education Reminder of Resources
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 (Pharmacy Services Resolution Help Desk)
Resolution Help Desk: 1-800-460-8988
Prior Auth Requests Phone: 1-866-399-0928
Prior Auth Requests Fax: 1-833-423-2523
Appeal Requests (Superior Prior Authorization Department)
Toll Free: 1-877-398-9461 ext. 22168