Texas Pharmacy Coverage | Ambetter from Superior HealthPlan

 

Pharmacy Resources

Ambetter takes our commitment to you seriously, and is honored to keep you covered during this unprecedented health situation.

For more details on COVID-19, Ambetter plan coverage, Telehealth, and prescription refills, please visit our FAQs page.

Ambetter from Superior HealthPlan is committed to providing appropriate, high quality, and cost effective drug therapy to all Ambetter from Superior HealthPlan members. Ambetter works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. Ambetter covers prescription medications and certain over-the-counter (OTC) medications when ordered by a practitioner. The pharmacy program does not cover all medications. Some medications require prior authorization (PA) or have limitations on age, dosage, and maximum quantities.

For more information about prior authorizations, visit Ambetter’s Pharmacy Program page.

Choosing a pharmacy

Ambetter has a variety of convenient in-network pharmacies. These include: HEB, CVS and Walmart, as well as many independent pharmacies in your area.

To find a network pharmacy near you, use our Find a Provider Tool and follow these steps:

  • Enter your zip code or address, or click Use my Current location.
  • Click Detailed Search and select Pharmacy from the Type of Provider drop-down menu.
  • If you are looking for a specific pharmacy like Home Infusion Therapy or Long Term Care, select that under the Specialty drop-down menu. Otherwise, you can skip this step.
  • If you need help finding a pharmacy, please call Member Services at 1-877-687-1196. Relay Texas/TTY users should call 1-800-735-2989.

More on Ambetter’s pharmacy program.

To find the cost of your medications please use our Drug Cost Tool.

Use our Preferred Drug List (Formulary) to find more information on the drugs that Ambetter covers.

Save Money and Get Your Prescriptions Delivered to Your Door!

CVS Mail Order

As an Ambetter member, you can maximize your pharmacy benefits by filling your prescriptions with CVS Caremark Mail Service Pharmacy, the only in-network mail order pharmacy. Eligible members pay only 2.5x* their regular copay for a three-month fill. Delivery is free and can be to your home, workplace, or any address you choose.

Prescription delivery may be right for you if you take
medications regularly for conditions like high blood pressure, arthritis or
diabetes.

Two easy ways to get started:

1.  Call your doctor and ask them to send a new 90-day prescription to CVS Caremark Mail Service Pharmacy.

2.  Or, request a new 90-day prescription at Caremark.com.

*2.5x copay is only applicable for three-month mail order fills from CVS Mail Order. All other three-month mail order fills will be subject to the standard 3x copay.

AcariaHealth

Need a specialty pharmacy for your complex or chronic conditions? Prescription home delivery is available to you.

Get your specialty medications mailed directly to your door, free of charge. AcariaHealth offers specialty prescription delivery services for those living with complex conditions or chronic illnesses, such as rheumatoid arthritis, multiple sclerosis, hepatitis C or cancer. AcariaHealth’s licensed pharmacists are also available to you 24/7 to discuss prescribed therapy and answer any questions regarding medications and supplies.

AcariaHealth will work with your current specialty pharmacy provider to seamlessly transition your medications safely and efficiently. To get started, contact us at 1-800-511-5144.

Hemophilia Network

Please refer to the link below for a comprehensive listing of Ambetter’s in-network hemophilia pharmacies.