Prescription medications play an important role in helping you stay healthy. Your plan includes coverage for these medications and follows the HHSC Formulary and Preferred Drug List (PDL). The pharmacy program is administered by Navitus Health Solutions, LLC.
To find a network pharmacy, use the Navitus online search tool or call Member Services at 1-888-672-2277 (STAR) or 1-888-814-2352 (CHIP).
Navitus Health Solutions
BIN# 610602
Claim PCN: MCD STAR
Rx Group # PCH
Copayments: Our members can get their prescriptions at no cost (Medicaid) or at low copays (CHIP) when:
- They get their prescriptions filled at a network pharmacy.
- Their prescriptions are on the preferred drug list (PDL) or formulary.
View the CHIP Cost Sharing Chart
A formulary is a list of medicines your plan covers. It includes the most commonly prescribed drugs that are safe, effective, and affordable. Your doctor can use this list to find the best medicine for your care.
Formulary/Preferred Drugs: Medications on this list are generally covered by your plan without prior authorization. View the formulary list.
Non-Formulary/Non-Preferred Drugs: Medications not listed in the formulary are considered to be non-formulary and are subject to prior authorization. Some medications listed may have additional requirements or limitations of coverage. These requirements and limits may include prior authorization, quantity limits, age limits, or step therapy.
Prior Authorization: Prior authorization is an approval that Parkland Community Health Plan requires for certain services and medications. Some services need approval before they are given. The provider who is treating you or your child should get this approval. You may ask your doctor or us if an approval is needed for a service or treatment. Your doctor can either complete the prior authorization request over the phone or complete a prior authorization form. Completed forms can be faxed or mailed to Navitus using the information below.
- Fax: 1-855-668-8553
- Mail: Navitus Health Solutions
Attn: Prior Authorization
1025 West Navitus Drive
Appleton, WI 54913
For questions or to submit a request by phone, call 1-877-908-6023
Monday–Friday, 6 am–6 pm; Saturday–Sunday, 8 am–noon.
Pharmacy Prior Authorizations Forms
Mail Order: Our Mail Order service through H-E-B Pharmacy offers a convenient way to receive your medications right at your doorstep. Instead of visiting a pharmacy in person, you can order your maintenance medications online or by phone and have them delivered safely and securely to your home. This service helps you save time, helps you keep up with refills, and may provide cost savings on certain medications.
72-Hour Emergency Fill: Federal and Texas law requires 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. This applies to non-preferred drugs on the Preferred Drug List and any drug that is affected by a clinical prior authorization 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.
Helpful Resources:
Direct Member Reimbursement Form
Mail Order Form
Override Request Form
Questions/Concerns: Contact PCHP Member Services: