Pharmacy

Pharmacy Information

Whether you are looking for information about covered services, specific treatment protocols or how claims are handled, your Parkland Community Health Plan provider manual is a comprehensive resource.

 

Parkland Community Health Plan, Inc contracts with Navitus Health Solutions http://www.navitus.com/ - 1-877-908-6023, to manage pharmacy network. The information for clinical edits for covered drugs, Drugs requiring prior authorization, Prior authorization criteria logic, Supporting tables, References, and Publication History.

For prior authorization requests, see numbers below or fax the pharmacy authorization form. Providers must download the form Pharmacy - Texas Standard Prior Authorization Request  and click Here and obtain the appropriate drug criteria from the Vendor Drug Program (VDP) website. The forms can be faxed to the number below.

Parkland has a single sign on for all Texas Medicaid and CHIP clinical edits. All Clinical edits are updated as required and managed appropriately.

Clinical Edits are now at this address:

https://txstarchip.navitus.com/pages/clinical-edits.aspx

PA forms (STAR/CHIP):

https://txstarchip.navitus.com/pages/prior-authorization-forms.aspx

Formularies (STAR/CHIP):

https://txstarchip.navitus.com/pages/formulary.aspx

Synagis info:

https://txstarchip.navitus.com/pages/synagis.aspx

Phone numbers:

Navitus (Pharmacy)

1-877-908-6023

BIN# 610602 Claim PCN: MCD STAR Claim Group – PHS and CHIP Claim Group – PHC

Prior Auth Fax

920-735-5312

At this time, there are no drug recalls.

Medicaid pays for most medicines. Providers will write a prescription so members can take it to the drug store, or providers may be able to send the prescription for the member.

List of pharmacies: Members may have to pay if they go to a drug store that is not in our network. For local pharmacies in Dallas SDA, Click Here.

Delivery service: Please visit the on-line pharmacy listing OR call Member Services at 1-888-672-2277 for drug stores that offer delivery.

72-Hour Emergency Supply: If a provider cannot be reached to approve a prescription, a member may be able to get a 72-Hour Emergency Supply of medication.

Lost medication: Lost or stolen medications are not a covered benefit.

Durable medical equipment (DME) or other products normally found in a pharmacy: Some durable medical equipment (DME) and products normally found in a pharmacy are covered by Medicare. For all members, Parkland HEALTHfirst pays for nebulizers, ostomy supplies, and other covered supplies and equipment if they are medically necessary. For children (birth through age 20), Parkland HEALTHfirst also pays for medically necessary prescribed over-the-counter drugs, diapers, formula, and some vitamins and minerals.

Call Member Services 1-888-672-2277 for more information about these benefits.

 

CHIP covers most of the medicine. Providers will write a prescription so members can take it to the drug store, or may be able to send the prescription to the member. Exclusions include contraceptive medications prescribed only for the purpose to prevent pregnancy and medications for weight loss or gain.

Members may have to pay a co-payment for each prescription filled depending on your income.

List of pharmacies. You can also call Member Services at 1-888-814-2352 for help. For local pharmacies in Dallas SDA, Click Here.

Delivery service: Please visit the on-line pharmacy listing OR call Member Services at 1-888-814-2352 for drug stores that offer delivery.

72-Hour Emergency Supply: If a Provider cannot be reached to approve a prescription, members may be able to get a 72-Hour Emergency Supply medication.

Lost medication: Lost or stolen medications are not a covered benefit.

Over-the-counter medication: The pharmacy cannot provide an over-the-counter medication as part of the CHIP benefit. If a member needs an over-the-counter medication, they will have to pay for it.

More than 34 days of a prescribed medication: The pharmacy can only give you an amount of a medication that the member need needs for the next 34 days.

Birth control pills: The pharmacy cannot give child birth control pills to prevent pregnancy. A member can only get birth control pills if they are needed to treat a medical condition.

For any questions, please call Parkland KIDSfirst Member Services toll-free at 1-888-814-2352.

You can find out if a medication is on the preferred drug list. Many preferred drugs are available without prior authorization (PA).

 

The formulary drug list is a list of drugs that are generally covered under the plan as long as they are medically necessary. If you want to request a drug to be added to the formulary, please contact your Provider Representative for assistance.

Providers can access the Navitus MAC portal.

Texas Vendor Drug Program      1-800-435-4165

Navitus Prescribers

Federal and Texas laws require pharmacies to dispense a 72-hour emergency supply of a prescribed drug when the medication is needed without delay and the prescriber is not available to complete the prior authorization. This applies to non-preferred drugs on the Preferred Drug List and any drug that is affected by a clinical Prior Authorization needing prescriber’s prior approval.

The pharmacy will submit an emergency 72-hour prescription when warranted. This procedure will not be used for routine or continuous overrides.

For further details about the 72-hour emergency supply requests, please refer to the Texas Vendor Drug Program.