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ALERTA: ¡Ahora el sitio web de Texas Children’s Health Plan es aún más sencillo de usar! Haz clic aquí para más información.
Pharmacy Alert!
Effective November 30, 2023, the Texas Health and Human Services Commission (HHSC) now covers Food and Drug Administration (FDA)-approved COVID-19 vaccines for Medicaid and CHIP members. Visit your local pharmacy if you would like to get the vaccine.
If you have any questions, call Member Services at 1-800-990-8247.
If you are pregnant, you can now get up to 90 days of prenatal vitamins through your Texas Children’s Health Plan pharmacy benefit. If you are a STAR or STAR Kids member, you will still have $0 copays. CHIP members will continue to pay their normal copay (if applicable) for a 3-month supply.
Prenatal vitamins are a covered benefit under the Texas Medicaid pharmacy benefit. You will need a prescription from your doctor to receive prenatal vitamins at your standard copay (if applicable).
The 90-day fill is limited to prenatal vitamins only. If you would like to know which prenatal vitamins are covered under the pharmacy benefit, visit www.txvendordrug.com/formulary/formulary-search.
If you currently don’t have a doctor, please call us at 1-866-959-2555 (STAR) or 1-866-959-6555 (CHIP) so we can assist you.
Pharmacy Hours Change Alert:
Effective March 2023, Walmart and CVS pharmacies have announced they will be changing their Pharmacy Hours of Operations. TCHP wants to make you aware of these changes and give you options to make sure there are no issues in obtaining your medication.
Walmart Pharmacies will be closing at 7:00 p.m. CT on weeknights. This change will impact 4,900 stores, many of which are in the Texas Children Health Plan (TCHP) covered-area. CVS has also announced over 9,000 locations will be changing their store hours. These store hours will vary by location.
Many of the pharmacies in the TCHP network offer delivery services. Please visit our Pharmacy Directory to find out if your pharmacy delivers. Go to the “Find a Pharmacy” link and click on advanced search button, then select “Delivery Service” under the Pharmacy Options section. You should then be able to enter your zip code and find all the pharmacies that deliver in your area.
TCHP members can also have medications delivered to them from a mail-order pharmacy. Our mail-order pharmacy is HEB based in San Antonio, TX, which delivers meds across the state. This HEB #647 mail-order pharmacy can be reached at 210-593-0291.
If you have any questions regarding these changes or would like to speak to a pharmacy team member about your medication, please give us a call on our Member Services line at 1-800-990-8247.
The Vendor Drug Program (VDP) made changes to the Texas Medicaid drug formulary effective August 8, 2024. To learn more about formulary changes impacted, please click here for more information.
For more than 25 years, Texas Children’s Health Plan has focused on helping the state’s most vulnerable children and pregnant women get and stay healthy. Our network offers a large range of healthcare providers that are close to where you live and work, and this includes pharmacy services.
The Texas Children's Health Plan Pharmacy Department gives pharmacy benefit services to our STAR and CHIP members. Our goal is to provide access to prescription medicine care and to be sure that services are:
A covered benefit.
Medically necessary.
Suitable to the patient's condition.
Provided in the proper setting.
Meet professional standards of pharmacy care.
Our “Find a Pharmacy” tool makes it simple to find a convenient pharmacy within our network. Click the button below to begin your search.
You can customize your search for a pharmacy by:
Type of plan or coverage.
Zip code, city and distance to you.
If you need help finding a pharmacy near you, call Member Services toll-free at 1-866-959-6555 (CHIP) or 1-866-959-2555 (STAR), or 1-800-659-5764 (STAR Kids).
You can make an online request for a pharmacy reimbursement on a medication that was paid out of pocket.
To submit your reimbursement request fill out the form.
Fill out the entire form and upload the required documents.
A decision will be made within one (1) business day of receipt.
If the reimbursement is approved, the refund will be processed and the payment will be sent via check. If the reimbursement is denied, a Pharmacy Technician will notify you of the decision.
If you go to a drug store that is not in our network, you may not be able to fill your medications, or may have to pay out of pocket yourself. You can ask for an exception for emergency situations. To submit an exception request, click here.
Texas Children’s Health Plan allows up to 34-days’ supply of medicines per fill. You may request an exception for a refill by contacting Member Services at 1-866-959-6555 (CHIP) or 1-866-959-2555 (STAR), or 1-800-659-5764 (STAR Kids).
Some medicines need a pre-approval before you can fill them at a drug store. Pre-approvals make sure that the drug is safe and effective and/or drugs not on the preferred drug list. Your doctor must submit a prior authorization request. We work with Navitus Health Solutions, a pharmacy benefit manager (PBM) to review prior authorization requests. Decisions are made within 72 hours. A list of prior authorization forms may be found on your online member portal, or at txstarchip.navitus.com under “Prior Authorization Forms.”
The Texas Children’s Health Plan Medicaid Prior Authorization clinical criteria is available from the Navitus pharmacy benefit manager website under “Clinical Edits.”
You can search for the preferred drug list (PDL) by visiting the Texas Health and Human Services (HHSC) Vendor Drug website at txvendordrug.com. The PDL is controlled by HHSC. Texas Children’s Health Plan is required to follow PDL requirements. The PDL is updated every 6 months in January and July. Texas Children’s will notify you directly if there are negative changes that impact your ability to obtain your medications. We also provide information on our website before a change.
If your or your child’s doctor cannot be reached to approve a prescription, you or your child may be able to get a three-day (72- hour) emergency supply of your or your child’s medication. Ask your drug store about providing you or your child an emergency supply. You can also call Texas Children’s Health Plan toll-free at 1-866-959-6555 (CHIP) or 1-866-959-2555 (STAR), or 1-800-659-5764 (STAR Kids) for help.
If you need your medication(s) delivered, you can use a pharmacy in our network that provides delivery services. You can search for a pharmacy that provides delivery services using our “Find a Pharmacy” online search tool, or you can call Member Services toll-free at 1-866-959-6555 (CHIP) or 1-866-959-2555 (STAR), or 1-800-659-5764 (STAR Kids).
If you lose your medications, you should call your doctor or clinic for help. If your doctor or clinic is closed, the drug store may be able to provide an emergency 72-hour supply. Sometimes, you may need special permission from the Texas Children’s Health Plan for an early refill. You can call Member Services toll-free at 1-866-959-6555 (CHIP) or 1-866-959-2555 (STAR), or 1-800-659-5764 (STAR Kids).
The pharmacy cannot give you an over-the-counter medication as part of your/your child’s Medicaid benefit. If you need/your child needs an over-the-counter medication, you will have to pay for it unless it is on the formulary and the provider writes a prescription for it.
The drug store can only give you an amount of a medication that you need/your child needs for the next 34 days. For exception requests, please call Texas Children’s Health Plan Member Services toll-free at 1-866-959-6555 (CHIP) or 1-866-959-2555 (STAR), or 1-800-659-5764 (STAR Kids).
You do not have a copayment for prescription medications covered under the Medicaid benefit.
Some Medicare plans may not have pharmacy benefit coverage. If you or your child have Medicare and Medicaid pharmacy benefit coverage, please bring both insurance cards to the Pharmacy. Medicare will pay first up to the limits of its coverage. Medicaid will cover the remaining costs if within the limits of its coverage. Medicines covered under Medicare-Medicaid dual coverage may not be the same as typical Medicaid only benefits.
If you are in a Nursing facility, they will provide you with medications.
Coverage does not include contraceptive medications prescribed only for the purpose of preventing a pregnancy and medications for weight loss or gain. You may have to pay a copayment for each prescription filled depending on your income. There are no copayments for CHIP Perinate Members.
The pharmacy cannot give you or your child birth control pills to prevent pregnancy. You or your child can only get birth control pills if they are needed to treat a medical condition.