[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-283857-105":53,"doc-detail-283857-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-physicians-formulary-preferrednon-preferred-drugs-and-prior-authorization","Pharmacy FAQ for Physicians - Formulary, Preferred/Non-Preferred Drugs, and Prior Authorization","","The document explains how the Texas Vendor Drug Program (TXVDP) formulary and clinical criteria determine drug coverage for Superior Medicaid (STAR, STAR+PLUS, STAR Health, STAR Kids) and CHIP, including how medications are categorized as preferred or non-preferred on the Medicaid Preferred Drug List (PDL). It clarifies when prior authorization is required, how non-preferred drugs may be covered in specific circumstances, and how the Texas DUR Board and Superior Pharmacy Therapeutics Committee influence formulary recommendations. It also summarizes formulary governance for Medicare and STAR+PLUS MMP and provides references to relevant coverage determinations and prior authorization resources.",{"@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":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/pharmacy-faq-for-physicians-formulary-preferrednon-preferred-drugs-and-prior-authorization/283857/",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-physicians-formulary-preferrednon-preferred-drugs-and-prior-authorization/283857.png","ImageObject",442,249,{"name":88,"@type":89},"Bintang","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","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},"Who determines the formulary for Texas Medicaid and CHIP programs, and what does it affect?","Question",{"text":108,"@type":109},"The Texas Vendor Drug Program (TXVDP) determines the Medicaid and CHIP formularies and clinical criteria. The formulary determines whether specific medications are covered under a member’s plan.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How do preferred and non-preferred drugs work on the Medicaid Preferred Drug List (PDL)?",{"text":113,"@type":109},"Preferred medications are listed on the TXVDP PDL and are considered covered, though some may require prior authorization based on clinical criteria. Non-preferred medications are listed on the PDL but are covered only through prior approval.",{"name":115,"@type":106,"acceptedAnswer":116},"When is prior authorization required for medication coverage?",{"text":117,"@type":109},"Prior authorization is required when a physician must obtain approval from Superior before Superior agrees to cover a medication. It ensures the medication is covered within the patient’s plan and is medically necessary and appropriate for the situation.","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},283857,1790871202,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"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":76,"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":9},962085564381,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Who determines the formulary, how does it affect me and where can I find the formulary?  \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 formulary, 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, however are only covered through prior approval. If a member has acontraindication/allergic reaction to a preferred drug or undergoing treatment of stage-four advanced, metastatic cancer and associated conditions, the non-preferred drug will be covered without trial of one or more preferred drugs.  \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-utilization-review-board](https://www.txvendordrug.com/resources/drug-utilization-review-board).  \nAllwell from Superior HealthPlan (Medicare) (HMO and HMO SNP), Ambetter 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 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 Therapeutics Committee 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/for](https://www.TXVendorDrug.com/for)[mulary/prior-authorization/preferred-](mulary/prior-authorization/preferred-)drugs\u003Cbr>• PDL Clinical Criteria, found at:\u003Cbr>[https://www.SuperiorHealthPlan.com](https://www.SuperiorHealthPlan.com)[ ](https://www.SuperiorHealthPlan.com)[/providers/resources/pharmacy/clinic](/providers/resources/pharmacy/clinic)al-prior-authorization. html\u003Cbr>• Quantity Limits, found at:\u003Cbr>[https://www.SuperiorHealthPlan.com](https://www.SuperiorHealthPlan.com)[ ](https://www.SuperiorHealthPlan.com)[/providers/resources/pharmacy.html](/providers/resources/pharmacy.html) | Medicaid/CHIP Prior Authorization Request Forms, found at:\u003Cbr>[https://www.SuperiorHealthPlan.com/providers/resources/f](https://www.SuperiorHealthPlan.com/providers/resources/f)orms. html\u003Cbr>Superior’s Pharmacy Benefit Manager (PBM), Envolve Pharmacy Solutions\u003Cbr>• Phone: 1-800-460-8988\u003Cbr>Prior Authorization:\u003Cbr>• Phone: 1-866-399-0928\u003Cbr>• Fax: 1-866-399-0929 |  |\n| Medicare:\u003Cbr>Allwell HMO\u003Cbr>Allwell HMO SNP | • Allwell HMO & HMO SNP Formulary, found at:\u003Cbr>[https://Al](https://Al)[lwell.SuperiorHealthPlan.co](lwell.SuperiorHealthPlan.co)m/prescription-drugs\u003Cbr>formulary/formulary. html | Allwell HMO & HMO SNP Coverage Determination and Redetermination Forms, found at:\u003Cbr>[https://Al](https://Al","cbCaivzxiUJaGYTB","https://ap.wps.com/l/cbCaivzxiUJaGYTB","pdf",211156,"English","# What is a formulary?\n## How preferred and non-preferred drugs are covered\n## Role of the Texas DUR Board\n## Medicare and STAR+PLUS formulary governance\n## Prior authorization overview","[{\"question\":\"Who determines the formulary for Texas Medicaid and CHIP programs, and what does it affect?\",\"answer\":\"The Texas Vendor Drug Program (TXVDP) determines the Medicaid and CHIP formularies and clinical criteria. The formulary determines whether specific medications are covered under a member’s plan.\"},{\"question\":\"How do preferred and non-preferred drugs work on the Medicaid Preferred Drug List (PDL)?\",\"answer\":\"Preferred medications are listed on the TXVDP PDL and are considered covered, though some may require prior authorization based on clinical criteria. Non-preferred medications are listed on the PDL but are covered only through prior approval.\"},{\"question\":\"When is prior authorization required for medication coverage?\",\"answer\":\"Prior authorization is required when a physician must obtain approval from Superior before Superior agrees to cover a medication. It ensures the medication is covered within the patient’s plan and is medically necessary and appropriate for the situation.\"}]","Pharmacy FAQ for Physicians - Formulary, Preferred/Non-Preferred Drugs, and Prior Authorization | PDF",1789620924]