ALERT: We have made the Texas Children’s Health Plan website even easier to use! Click here to learn more.
ALERTA: ¡Ahora el sitio web de Texas Children’s Health Plan es aún más sencillo de usar! Haz clic aquí para más información.
Attention: Star Kids Providers: Prior Authorization required on all Vendor Drug Program (VDP) identified medications
Texas Children’s Health Plan requires prior authorization (PA) on all medications on the VDP website prior to dispensing to members. To obtain a list of medications requiring prior authorization, visit the VDP website at:
http://www.txvendordrug.com/formulary/preferred-drugs.shtml
Providers can also view instructions on accessing and using the formulary at the Texas Children’s Health Plan website:
http://www.thecheckup.org/2016/06/09/do-you-know-how-to-access-the-texas-childrens-health-plan-formulary/
Providers can submit PA documentation to Texas Children’s Health Plan’s pharmacy benefit manager, Navitus. PA forms can be found here:
https://www.navitus.com/texas-medicaid-star-chip/prior-authorization-forms.aspx
Prior authorizations need to be submitted to Navitus by faxing to 855-668-8553 and for questions please contact Navitus Customer Care at 877-908-6023.
If the prior authorization request is denied, Providers may request an appeal by faxing the request to 832-825-8796. To assist Texas Children’s Health Plan in your request, please include the following information in your submission:
- The reason for your appeal
- A copy of the Navitus denial letter
- A copy of documentation submitted to Navitus for prior authorization
- Clinical documentation supporting the use of the medication