Pharmacy information for providers, including contact information and formulary details, can be found on this page. CarelonRx* is the pharmacy benefits manager.
Medicaid and CHIP formulary and Medicaid preferred drug list (PDL)
Texas Vendor Drug Program clinical edits
These clinical prior authorizations apply to patients enrolled in traditional Medicaid. Texas Vendor Drug Program clinical edits can be accessed through the Texas HHS Vendor Drug Program (VDP) website .
Providers are encouraged to write prescriptions for preferred products as listed on the Texas Medicaid formulary and preferred drug list (PDL), available on the Texas HHS Vendor Drug Program (VDP) website .
If, for medical reasons, a member cannot use a preferred product, providers are required to contact the Pharmacy department at Wellpoint at 1-833-731-2162 to obtain prior authorization. CHIP members’ claims will not require PDL prior authorization.
Medications that require prior authorization may include:
- Drugs listed as nonpreferred on the PDL or drugs that require clinical prior authorization
- Select self-administered injectable products
- Drugs that exceed certain cost and/or dosing limits. (For information on these limits, call the Wellpoint Pharmacy at 1-833-731-2162.)
Note: This list is not all-inclusive and is subject to change.
Pharmacy prior authorization submissions
Online pharmacy prior authorization can be found through CoverMyMeds
Pharmacy prior authorization fax:
Pharmacy phone (at Wellpoint):
Available 7 a.m. to 10 p.m.
Medical injectable/infusible drugs prior authorization fax:
Prior authorization fax:
All Wellpoint Medicare Advantage plans include coverage of Medicare Part D prescription drugs, as well as those covered under Medicare Part B.
Formulary for individual Medicare Advantage products:
Medicare Part D Rx coverage determinations
Providers can send a request for a prescription coverage determination for a Medicare plan via electronic prior authorization (ePA) rather than fax or phone by submitting the request from one of the following ePA websites:
Wellpoint STAR+PLUS MMP (Medicare-Medicaid Plan)
Members have access to most national pharmacy chains and many independent retail pharmacies that are contracted with us. Members may obtain their medications at any network pharmacy.
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub
- Learn about Availity
- Precertification Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)