PCHP covers prescription medications, and our pharmacy plan is administered by Navitus. Our members can get their prescriptions at no cost (Medicaid) or at low co-pays (CHIP) when:
- They get their prescriptions filled at a network pharmacy.
- Their prescriptions are on the preferred drug list (PDL) or formulary.
Navitus Texas Provider Hotline (Pharmacy): 1-877-908-6023
Preferred Drugs: You can find out if a medication is on the preferred drug list. Many preferred drugs are available without prior authorization (PA).
Formulary Drugs: Medications are generally covered under the plan as long as they are medically necessary. If you want to request a drug to be added to the formulary list, please contact your Provider Representative for assistance.
Non-Formulary 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.
Generic Drugs: Additionally, if a medication is available as a generic formulation, this will be PCHP's preferred agent, unless otherwise noted. If a brand name medication is requested when a generic exists, a prior authorization request will need to be submitted.
Drug Coverage: For questions about coverage of a certain product, please contact us at 1-888-672-2277.
Mail Order: You can assist your member in completing the MOD prescription form if you are prescribing a maintenance medication. Mail order is optional.
72-Hour Emergency Fill: 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, visit the Texas HHS VDP website.