Pharmacy information

Prior authorizations

Providers are encouraged to write prescriptions for preferred products as listed on the Texas Medicaid formulary and preferred drug list (PDL), available on the Texas HHS Vendor Drug Program (VDP) website .

If, for medical reasons, a member cannot use a preferred product, providers are required to contact the Pharmacy department at Wellpoint at 1-833-731-2162 to obtain prior authorization. CHIP members’ claims will not require PDL prior authorization.

Pharmacy department:

1-833-731-2162

Medications that require prior authorization may include:

• Drugs listed as nonpreferred on the PDL or drugs that require clinical prior authorization
• Select self-administered injectable products
• Drugs that exceed certain cost and/or dosing limits. (For information on these limits, call the Wellpoint Pharmacy at 1-833-731-2162.)

Note: This list is not all-inclusive and is subject to change.

Pharmacy prior authorization fax:

1-844-474-3341
Available 24/7.

Pharmacy phone (at Wellpoint):

1-833-731-2162
Available 7 a.m. to 10 p.m.

Medical injectable/infusible drugs prior authorization fax:

Prior authorization fax:

1-844-512-8995
Available 24/7.

Medicare

All Wellpoint Medicare Advantage plans include coverage of Medicare Part D prescription drugs, as well as those covered under Medicare Part B.

Formulary for individual Medicare Advantage products:

Coming soon!

Medicare Part D Rx coverage determinations

Providers can send a request for a prescription coverage determination for a Medicare plan via electronic prior authorization (ePA) rather than fax or phone by submitting the request from one of the following ePA websites: