The following contact numbers depict the pharmacy related services provided by CHRISTUS Health Plan as well as the contact information:
Coverage Determination (ESI)
Standard/Expedited Coverage Review: 1-800-935-6103
Formulary Exceptions (ESI)
Coverage Review: 1-800-935-6103
Members can use the mail-order service to fill prescriptions for maintenance drugs (i.e., drugs taken on a regular basis for a chronic or long-term medical condition). For mail-order prescriptions, the provider must write on the maintenance drug prescription whether it is for a 31-, 62- or 93-day supply. When mailing in a prescription to the mail-order service for the first time, the member should allow up to two weeks for the prescription to be filled. For refills of the same prescription, members should allow up to 7-10 days for mailing and processing.
If a member runs out of a medication before receiving a new supply from the mail-order pharmacy, please call 1-844-470-1531.
An expedited decision can only be requested if the member or any provider believes waiting for a standard decision could jeopardize the member’s life, health or ability to regain maximum function. This is called the expedited criteria. The member or a provider can request an expedited decision. If a provider requests an expedited decision or supports a member in asking for one and if the provider indicates the situation meets the expedited criteria, CHRISTUS Health Plan will automatically provide an expedited decision within 24 hours from the initial request.
If a prescription drug is not listed in the CHRISTUS Health Plan formulary, please check the updated formulary on the Express Scripts website. The website formulary is updated frequently with any changes.If the drug is not on the formulary, there are two options:
In some cases, CHRISTUS Health Plan will contact a member who is taking a drug that is not on the formulary. CHRISTUS Health Plan will give the member the names of covered drugs used to treat his or her condition and encourage the member to ask his or her provider if any of those drugs would be appropriate options for treatment. Also, members who recently joined CHRISTUS Health Plan may be able to get a temporary supply of a drug they are taking if the drug is not on the CHRISTUS Health Plan formulary.
Please refer to the Provider Manual.