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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 1-866-768-7147.

For information regarding contracting as a network pharmacy please visit the Express Scripts 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 Express Scripts.


To locate Ambetter from Superior HealthPlan Pharmacy Resources, please visit Ambetter's Pharmacy webpage.

Medicaid/CHIP Pharmacy Help Desk
Toll Free: 1-800-311-0552

Prior Auth Requests
Phone: 1-866-399-0928
Fax: 1-833-423-2523

Medicare Pharmacy Help Desk
Toll Free: 1-877-935-8021

Prior Auth Requests

Phone: 1-866-399-0928
Fax: 877-941-0480

Clinician Administered Drugs
Phone: 1-866-768-7147 ext. 6081112
Fax: 1-866-683-5631

Out-Patient Rx (Pharmacy Services Resolution Help Desk) 
Resolution Help Desk: 1-866-768-7147 ext. 6081112

TTY: 1-866-492-9674
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
Fax: 1-866-918-2266