[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-283856-105":53,"doc-detail-283856-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","pharmacy-faq-for-pharmacies","Pharmacy FAQ - For Pharmacies","","Pharmacy FAQ content explains how the formulary is determined, how it affects drug coverage under different insurance programs, and where pharmacies can find formulary and criteria information. It defines formularies as lists of covered drugs tied to medical necessity, network dispensing rules, and additional coverage limits. The material distinguishes preferred versus non-preferred status, outlines prior authorization requirements, and describes how the TXVDP Preferred Drug List and clinical criteria are reviewed. It also summarizes DUR Board processes and provides formulary and prior authorization contact and resource details for Medicaid/CHIP, Medicaid-Medicare, and Marketplace plans.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/pharmacy-faq-for-pharmacies/283856/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/pharmacy-faq-for-pharmacies/283856.png","ImageObject",442,249,{"name":88,"@type":89},"นรินทร์","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-24","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":15},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is a formulary and how does it impact drug coverage?","Question",{"text":108,"@type":109},"A formulary is a list of drugs covered by an insurance plan. Coverage generally applies when the drug is medically necessary, dispensed through an applicable network pharmacy/mail order option, and all other coverage rules are met.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What are the differences between preferred and non-preferred medications?",{"text":113,"@type":109},"Preferred products are covered when listed on the TXVDP PDL, though some may still require clinical review via prior authorization. Non-preferred products require prior approval, and members must try at least one preferred medication first.",{"name":115,"@type":106,"acceptedAnswer":116},"Who determines the formulary and where can pharmacies find formulary resources?",{"text":117,"@type":109},"For Medicaid programs, formulary and clinical criteria follow the Texas Vendor Drug Program (TXVDP) and Medicaid/CHIP requirements; the Texas DUR Board meets quarterly to recommend updates. Ambetter and STAR+PLUS Medicaid-Medicare formularies are determined by the Centene Corporate Pharmacy and Therapeutic (P&T) Committee using clinical and economic criteria. Plan-specific formulary, criteria, prior authorization forms, and help desk contact details are provided in the document tables.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},283856,1791500323,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":15,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":73},2336475104957,"https://ap-avatar.wpscdn.com/avatar/22000c4c6bd8a5076e1?x-image-process=image/resize,m_fixed,w_180,h_180&k=1787554080175789136","Who determines the formulary, how does it affect me and where can I find the formulary?  \nA formulary is a list of all the drugs that are covered by an insurance plan. In general, the drugs listed in the formulary are covered as long as the drug is medically necessary, the prescription is filled through a network pharmacy or network mail order facility (when applicable) and other coverage rules are followed. For some drugs, there may be additional requirements or limits to coverage.  \nSuperior Medicaid (STAR, STAR+PLUS, STAR Health, STAR Kids) and Children’s Health Insurance Plan (CHIP) programs must adhere to the Medicaid and CHIP formularies and clinical criteria determined by the Texas Vendor Drug Program (TXVDP) . The Medicaid formulary includes a Preferred Drug List (PDL) . Medications on the Medicaid formulary (PDL) are described as preferred and non-preferred. Medications on the CHIP formulary do not have a status of preferred or non-preferred. If medications are listed on the Medicaid and CHIP formularies , they are covered, but if they are not listed , they are not covered.  \n• Preferred: Products are listed on the TXVDP PDL and are considered covered. Please note: some products may require review of clinical criteria through submission of a prior authorization in order to obtain approval.  \n• Non-preferred: Products are listed on the TXVDP PDL are only covered through prior approval. Members must try at least one preferred medication first.  \nThe Texas Drug Utilization Review (DUR) Board meets quarterly to recommend products for the TXVDP PDL and review medical/therapeutic criteria. Additional information about the Texas DUR Board can be found at [https://www.txvendordrug.com/resources/drug-uti](https://www.txvendordrug.com/resources/drug-uti)lization-review-board.  \nAmbetter from Superior HealthPlan (Marketplace), and STAR+PLUS Medicaid-Medicare (MMP) each follow their own formulary. These formularies are determined by the Centene Corporate Pharmacy and Therapeutic (P&T) Committee, who utilize clinical and economic criteria to determine which medications to cover on each formulary.  \nNot all drugs are included on the various formularies. Each formulary is reviewed by independent physicians and pharmacists on Superior’s Pharmacy and Therapeutics Committee, similar to the Corporate P&T members, for any recommendations to state Drug Utilization Review (DUR) board or to Corporate P&T committees for their consideration. Please reference the table below for formularies and pharmacy resources for each product.  \n\n| Formulary and Prior Authorization Information |  |  |  |\n| --- | --- | --- | --- |\n| Product | Formulary/Criteria | Forms/Phone/Fax |  |\n| Medicaid/CHIP:\u003Cbr>STAR\u003Cbr>STAR Health\u003Cbr>STAR Kids\u003Cbr>STAR+PLUS CHIP | • TXVDP Preferred Drug List found at:\u003Cbr>[https://www.TXVendorDrug.com/formulary/p](https://www.TXVendorDrug.com/formulary/p)[rior-authorization/preferred-drugs](rior-authorization/preferred-drugs)\u003Cbr>• PDL Clinical Criteria found at:\u003Cbr>[https://www.SuperiorHealthPlan.com/provide](https://www.SuperiorHealthPlan.com/provide)[rs/resources/pharmacy/clinical-prior-](rs/resources/pharmacy/clinical-prior-)[authorization.html](authorization.html)\u003Cbr>• Quantity Limits found at:\u003Cbr>[https://www.SuperiorHealthPlan.com/provide](https://www.SuperiorHealthPlan.com/provide)[rs/resources/pharmacy.html](rs/resources/pharmacy.html) | Medicaid/CHIP Prior Authorization Request Forms\u003Cbr>found at:\u003Cbr>[https://www.SuperiorHealthPlan.com/providers/resourc](https://www.SuperiorHealthPlan.com/providers/resourc)[es/forms.html](es/forms.html)\u003Cbr>The Pharmacy Relations and Provider Help Desk:\u003Cbr>• Phone: 1-800-460-8988\u003Cbr>Pharmacy Relations and Pharmacy Services Prior Authorization and Coverage Determination Department\u003Cbr>• Phone: 1-866-399-0928\u003Cbr>• Fax: 1-833-423-2523 |  |\n| Medicaid-Medicare:\u003Cbr>STAR+PLUS MMP | • STAR+PLUS MMP Formulary found at:\u003Cbr>[https://MMP.SuperiorHealthPlan.com/mmp/p](https://MMP.SuperiorHealthPlan.com/mmp","cbCaiiAoTUz32SQP","https://ap.wps.com/l/cbCaiiAoTUz32SQP","pdf",234828,"English","# What determines the formulary, and how does it affect me?\n## What is a formulary?\n## Preferred versus non-preferred coverage\n## Texas Vendor Drug Program (TXVDP) PDL and DUR Board\n## How different plans determine formularies","[{\"question\":\"What is a formulary and how does it impact drug coverage?\",\"answer\":\"A formulary is a list of drugs covered by an insurance plan. Coverage generally applies when the drug is medically necessary, dispensed through an applicable network pharmacy/mail order option, and all other coverage rules are met.\"},{\"question\":\"What are the differences between preferred and non-preferred medications?\",\"answer\":\"Preferred products are covered when listed on the TXVDP PDL, though some may still require clinical review via prior authorization. Non-preferred products require prior approval, and members must try at least one preferred medication first.\"},{\"question\":\"Who determines the formulary and where can pharmacies find formulary resources?\",\"answer\":\"For Medicaid programs, formulary and clinical criteria follow the Texas Vendor Drug Program (TXVDP) and Medicaid/CHIP requirements; the Texas DUR Board meets quarterly to recommend updates. Ambetter and STAR+PLUS Medicaid-Medicare formularies are determined by the Centene Corporate Pharmacy and Therapeutic (P\\u0026T) Committee using clinical and economic criteria. Plan-specific formulary, criteria, prior authorization forms, and help desk contact details are provided in the document tables.\"}]","Pharmacy FAQ - For Pharmacies | PDF",1789620924]