As a STAR Kids member, your child has access to prescription drug coverage, including pharmacy benefits. Pharmacy benefits for the Texas STAR Kids program are determined by the Medicaid Vendor Drug Program (VDP). Your child’s pharmacy benefits are administered by the Blue Cross and Blue Shield of Texas (BCBSTX) STAR Kids Plan. These benefits include coverage for selected prescription and over-the-counter (OTC) drugs and medical supplies.
The STAR Kids 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.
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 your doctor for them
- You fill the prescription at a network pharmacy
- You follow the plan rules
Certain drugs on the list need prior authorization. Your doctor will need to request approval before these drugs can be prescribed. Without approval, the drugs are not covered. If your doctor wants your child 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.
To protect your child’s health, make sure your doctor and pharmacist know all the medicines your child is taking, including OTC drugs.
STAR Kids Dual Members
STAR Kids Dual members are individuals who are both Medicare eligible and also eligible for 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. Medicaid is the payor of last resort and provides the wraparound benefit.
BCBSTX will continue to pay for some drugs not covered by Medicare (wraparound benefit), including:
- Over-the-counter drugs
- Cough and colds products
- Vitamins and mineral products
- Limited home health supplies
If you have not enrolled in a Part D prescription drug plan or have issues obtaining your Medicare drugs, contact the Limited Income Newly Eligible Transition (LI-NET) program at 1-800-783-1307 for help.
Our network has many pharmacies for you to use.
Prescription Drug Forms
The following prescription drug forms are available as PDF files. Just click on a form to download it. Have your doctor fax in completed forms at 1-877-243-6930. Your doctor can also submit online or call 1-855-457-0407. You will need Adobe Reader to view these files; this can be downloaded free of charge at Adobe's site Opens in new window
- Drug Specific Prior Authorization Forms Opens in new window
- Prescription Drug Claim Form
- Texas Standard Prior Authorization Request Form for Prescription Drug Benefits
Prime Therapeutics, LLC, is the pharmacy benefit manager for Blue Cross and Blue Shield of Texas.