Pharmacy benefits for the Texas STAR program are determined by Medicaid/CHIP Vendor Drug Program (VDP) and are administered by Blue Cross and Blue Shield of Texas (BCBSTX). This includes coverage for selected prescription and over-the-counter (OTC) drugs, and selected medical supplies. This plan goes by a list of preferred drugs. The Drug List (also called a formulary) is a list showing the drugs that can be covered by the plan. The list includes generic, brand and OTC drugs and medical supplies.
As a STAR member, you pay nothing ($0) for the items on the Drug List. Those items will be covered as long as you:
Certain drugs on the list need prior authorization and 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.
There are many ways your doctor may submit a prior authorization request.
To protect your health and keep you safe, make sure your doctor and pharmacist know all the medicines you are taking, including OTC drugs.
Our network has many pharmacies for you to use.
Prime Therapeutics, LLC, is the pharmacy benefit manager for Blue Cross and Blue Shield of Texas.