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Texas Pharmacy Coverage | Ambetter from Superior HealthPlan
Important Notice Regarding Pharmacy Benefit Managers
Effective January 1, 2024, your health plan is changing pharmacy benefit managers from CVS to Express Scripts®.
Ambetter from Superior HealthPlan is committed to providing appropriate, high quality, and cost effective drug therapy to all Ambetter from Superior HealthPlan members. Ambetter Health works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. Ambetter Health 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 Health’s Pharmacy Program page.
Choosing a pharmacy
Ambetter Health 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.
Use our Preferred Drug List (Formulary) to find more information on the drugs that Ambetter Health covers.
- 2024 Formulary/Prescription Drug List (PDF)
- 2024 Formulary Changes (PDF)
- 2023 Formulary/Prescription Drug List (PDF)
- 2023 Formulary/Prescription Drug List - Spanish (PDF)
- 2023 Formulary/Prescription Drug List - Chinese (PDF)
- 2023 Formulary/Prescription Drug List - Vietnamese (PDF)
- 2023 Formulary Changes (PDF)
- Extended Day Supply Pharmacies are now listed in our Find a Provider tool
- 90-Day Extended Supply Medications (PDF)
- Medical Drug Document (PDF)
Save Money and Get Your Prescriptions Delivered to Your Door!
As an Ambetter Health member, you can maximize your pharmacy benefits by filling your prescriptions with CVS Caremark or Kroger Mail Service Pharmacies, the only in-network mail order pharmacies. 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
CVS Mail Order
- Call your doctor and ask them to send a new 90-day prescription to CVS Caremark Mail Service Pharmacy.
- Or, request a new 90-day prescription at Caremark.com.
*2.5x copay is only applicable for three-month mail order fills from CVS or Kroger Mail Order. All other three-month mail order fills will be subject to the standard 3x copay.
Kroger Mail Order
- Create an account* at the Postal Prescription Service (PPS) website which services the Kroger chain at ppsrx.com.
- Or, call the PPS Customer Service Center at 1-800-552-6694.
For more information, you can review the PPS Quick Reference Guide and FAQs (PDF).
*Please note – You must set up an account when you have a prescription you need to fill. You are not able to set up an account in advance.
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.
Please refer to the link below for a comprehensive listing of Ambetter Health’s in-network hemophilia pharmacies.