STAR Kids Prescription Drug Coverage

As a Blue Cross and Blue Shield of Texas STAR Kids plan member, you have pharmacy benefits. The benefits for the Texas STAR Kids program are determined by the Medicaid Vendor Drug Program (VDP) and are administered by BCBSTX. This means select generic and brand-name prescription drugs, medical supplies and over-the-counter (OTC) drugs are covered. 

This plan goes by a list of preferred drugs. The Drug List (also called a formulary) is a list showing the drugs and medical supplies that can be covered by the plan.

• Search the VDP Drug List
• VDP Drug List (machine-readable file)* – Download a machine-readable version of the VDP Drug List that is in accordance with CMS regulations and guidance.

STAR Kids members pay nothing ($0) for the items on the Drug List. Those items will be covered as long as:

• Your child has a medical need for them.
• Your child has a prescription from their doctor for them.
• You fill the prescription at a network pharmacy.
• You follow the plan rules.

Prior Authorization

Certain drugs on the list may need a prior authorization (“PA”). Your doctor will need to request approval before these drugs can be prescribed. Without approval, the drugs are not covered. If your doctor wants you to have a drug that is not on the list, he or she can request approval for that drug. For some drugs, the plan limits the amount that will be covered. You can find out if your drug has any added conditions or limits by looking at the Drug List.

Here are ways your doctor may submit a PA request:

• Submit online requests
• Call 1-855-457-0407
• Fax in completed forms at 1-877-243-6930. 
• Prior Authorization Drug List
• Prior Authorization Drug List (machine-readable file)*

STAR Kids Dual Members

STAR Kids Dual plan members are those who are eligible for both Medicare and some level of Medicaid prescription coverage.

Most drugs are covered by another primary Medicare Part D insurance plan and follow Medicare rules. Pharmacies should bill these drugs directly to the other primary Medicare Part D plan. Please note that Medicaid:

• Is the payor of last resort,
• Provides the wraparound benefit, and 
• Only pays what Medicare does not pay for covered drugs.

BCBSTX will continue to pay for some drugs not covered by Medicare (wraparound benefit). Examples include:

• Over-the-counter drugs
• Cough and colds products
• Vitamins and mineral products
• Limited home health supplies

What if you have not enrolled in a Part D prescription drug plan or have issues obtaining your Medicare drugs? Just contact the Limited Income Newly Eligible Transition (LI-NET) program at 1-800-783-1307 for help.

Find out more about the Medicare LI-NET program.

Home Delivery (Mail-Order Service)

Are there medicines that you take regularly or long-term? Regular medicines are taken sometimes more than once a day or many times a week. These drugs can also be taken long-term, for more than 3 months. They may treat chronic conditions like high cholesterol, high blood pressure, asthma or depression and anxiety. You can order the drugs that you take long-term or every day through the Walgreens Mail Service and have them delivered to your home.

This home delivery service offers:

• Up to a 90-day supply of your regular or long-term medicine mailed at one time
• Three ways to order refills: online, by phone or through the mail
• A choice to get a text or email notice to let you know when they have received your order, and to let you know when your prescription has been mailed

Walgreens Mail Service

• Review the Mail Service Pharmacy brochure for more information.
• Fill out the Mail Service Registration and Prescription Order Form to get started.

Download Rx Forms

The following prescription drug forms are PDF files. Have your doctor complete and submit these forms.

Prior Authorization (PA) Forms 

Have your doctor submit a PA request online to Cover My Meds. They can also fax in completed forms at 1-877-243-6930. Or your doctor can call 1-855-457-0407. 

• Drug Specific Prior Authorization Forms
• Texas Standard Prior Authorization Request Form for Prescription Drug Benefits

Other Prescription Drug Forms

If you or your provider have questions about these forms, call the Customer Advocate Department at 1-877-688-1811 (TTY: 711).

• Prescription Drug Claim Form
• Mail Service Registration and Prescription Order Form

Frequently Asked Questions

Check the FAQs to learn more about your Rx benefits.

* Please note: This is a large file. It may take longer to download. Internet speed, browser and computer hardware may impact your download time.

Prime Therapeutics LLC is a separate company contracted by Blue Cross and Blue Shield of Texas to provide pharmacy solutions. Blue Cross and Blue Shield of Texas, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC. MyPrime.com is a pharmacy benefit website offered by Prime Therapeutics LLC.