CHRISTUS Health Plan contracts with CVS Caremark to manage the pharmacy network.
Pharmacy benefits are coordinated through CVS Caremark.CHRISTUS Health Plan covers prescription medications. Our members can get their prescriptions at no cost (Medicaid) or at low copays (CHIP) when:
It is important that you as the provider know about other prescriptions your patient is already taking. Also, ask them about non-prescription medicine or vitamin or herbal supplements they may be taking.
View the 2016 Pharmacy Formulary. If you want to request a drug to be added to the formulary, please contact a CHRISTUS Health Plan Provider Representative for assistance at: 1-877-428-3057 (Medicaid) or 1-800-359-5613 (CHIP). You can access the MAC here.
CHRISTUS Health Plan also covers certain over-the-counter drugs if they are on the formulary list. Some of these may have rules about whether they will be covered. If the rules for that drug are met, CHRISTUS Health Plan will cover the drug. Check the list of covered drugs at Texas Vendor Drug Program.
All prescriptions must be filled at a network pharmacy. Prescriptions filled at other pharmacies will not be covered.
Electronic Prescribing (e-prescribing, or eRx) supports a physician’s ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy.
CHRISTUS Health Plan and CVS Caremark provide for the submission of both paper and electronic prescriptions. Providers engaged in e-prescribing must do so in accordance with all applicable state and federal laws.
You can assist your member in completing the mail-order form if you are prescribing a maintenance medication. Find answers to frequently asked questions (FAQs) about mail-order services here.
To obtain a Prior Authorization, providers can call CVS Caremark at 1-855-656-0363 or fax an authorization form designed specifically for pharmacy requests. Download the forms here and fax the request to 1-866-255-7569.
Please also include any supporting medical records that will assist with the review of the prior authorization request. For all requests, allow 24 hours to complete the authorization process.
You can find out if a medication is on the preferred drug list. Many preferred drugs are available without prior authorization (PA). The Texas Medicaid preferred drug list is now available on the Epocrates drug information system at https://online.epocrates.com/. The service is free and provides instant access to information on the drugs covered by the Texas formulary on a Palm or Pocket PC handheld device.
Federal and Texas law require pharmacies to dispense a 72-hour emergency supply of a prescribed drug when the medication is needed without delay and the prescriber is not available to complete the prior authorization.
Applies to non-preferred drugs on the Preferred Drug List and any drug that is affected by a clinical PA needing prescriber’s prior approval.
The pharmacy will submit an emergency 72-hour prescription when warranted; this procedure will not be used for routine and continuous overrides.
For further details on the 72-hour emergency supply requests, please refer to the Texas Vendor Drug Program.
The Medicaid Comprehensive Care Program (CCP) can cover medically necessary drugs and supplies that are not covered by the Vendor Drug Program for members from birth through 20 years of age. Your patients can call TMHP at 1-800-335-8957 to locate a participating CCP pharmacy provider.
Pharmacies are encouraged to provide some limited Durable Medical Equipment (DME) and medical supplies to Medicaid (STAR) and CHIP plan members. Participating pharmacies are eligible to provide the limited approved DME and medical supplies that are covered under the state of Texas Medicaid (STAR) and CHIP programs. Click here for more information about DME benefits.
From drug lists and mail service information to clinical programs and publications, find the resources you need to help your patients manage their health through CVS Caremark.