CHIP Prescription Drug Frequently Asked Questions

  • What Are My Prescription Drug Benefits?

    BCBSTX covers most of the prescription drugs that your Primary Care Provider (PCP) may think you need. BCBSTX uses a chosen list of drugs called a preferred drug list to help your doctor choose which drugs to give you. Certain drugs on this list need approval ahead of time or have limits based on medical necessity. In these cases, your doctor must ask for approval before you get the drug.

    You must get our approval before we pay for drugs that are not on the list. If your doctor thinks you need to take a drug that is not on the list, he or she will send us a request that tells us why you need the drug. We will let your doctor know if we say “yes” to your request within 24 hours. If we get the request after hours, we will let your doctor know on the next business day. Your pharmacist can ask for a 72-hour supply of the drug if we get the request after hours. If we say “no” to your request, you will get a letter that tells you the medical reasons why. You can appeal the decision. Learn more about your appeal rights.

    There are two kinds of drugs on the preferred drug list: brand-name and generic. A brand-name drug is a drug that is made by one company. A generic drug is the same drug without a brand. Generic drugs are approved by the Food and Drug Administration (FDA) and they are a safe, equally effective option to brand-name drugs. Generic drugs require the same testing as brand-name drugs, and are no different when it comes to strength, dosage, form, route of administration or intended usage. You can often buy brand-name and generic drugs at the same pharmacy.

    Most of the time, brand-name drugs are covered only if there is no generic drug available. We may pay for brand-name drugs in cases where your doctor writes on the prescription that you need the brand-name drug or if a brand-name drug is preferred by Medicaid.

    To find out if a drug is on our list, please call our Customer Care Center at 1-888-657-6061 or the TTY number at 7-1-1 or visit the formulary drug search Learn more about third-party links.

  • How do I get my prescriptions? What do I bring with me to the pharmacy?

    Your doctor will write a prescription so you can take it to the pharmacy, or your doctor may be able to send the prescription for you. Make sure to take your BCBSTX ID card and Your Texas Benefits Medicaid Card to the pharmacy with you.

  • Where do I get my prescriptions filled? How do I find a network pharmacy?

    You can get your prescriptions at one of our many network pharmacies. You can find a list of these pharmacies in our Pharmacy Directory or you may call our Customer Care Center at 1-888-657-6061. Members with hearing or speech loss may call the TTY line at 7-1-1. Try to use the same pharmacy to get more personal service.

    Find a pharmacy

    Download a printable version of the CHIP Pharmacy Directory CHIP Pharmacy Directory PDF Document

  • What if I go to a pharmacy not in the network?

    If you go to a pharmacy that is not in the network, ask the pharmacy staff to call our Customer Care Center at 1-888-657-6061.

  • How do I get my prescriptions if I am traveling or out of the service area?

    If you need to fill a prescription while you are traveling or out of the service area, call our Customer Care Center at 1-888-657-6061. Members with hearing or speech loss may call the TTY line at 7-1-1.

  • What if I can't get the medication my doctor ordered approved?

    If your doctor cannot be reached to approve a prescription, you may be able to get a three-day emergency supply of your medication. Call our Customer Care Center toll-free at 1-888-657-6061 for help with your medications and refills.  Members with hearing or speech loss may call the TTY line at 7-1-1.

  • Who do I call if I have problems getting my prescriptions or if I lose my medications?

    Call our Customer Care Center toll-free at 1-888-657-6061 if you have problems getting your prescriptions or if you lose your medications. Members with hearing or speech loss may call the TTY line at 7-1-1.

  • Are there any limits to my Prescription Drug Benefit?

    These are some of the limits that apply to your Prescription Drug Benefit:

    • Medication supply is limited up to to a 34-day supply.
    • Some supplies are covered by your medical benefits, not your pharmacy benefits. This includes:
      • Blood sugar monitors
      • Nutritional products
      • Nebulizers
    • Injections that must be given by your PCP (office-based injections) are covered by your medical benefits, not your pharmacy benefits.
    • We do not cover:
      • Drugs used to treat erectile dysfunction
      • Drugs ordered mostly for cosmetic reasons
      • Drugs used to help hair grow
      • Drugs not approved by the FDA

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