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Pharmacy Benefit Manager

Pharmacy

Navitus Health Solutions is the Pharmacy Benefits Manager for CFHP.

Navitus maintains the drugs that require prior authorizations, Prior authorization criteria logic, Supporting tables, Clinical publications and sources relevant to the clinical edit, Publication history.

https://www.navitus.com/texas-medicaid-star-chip/Clinical-Edits.aspx

Information must be accurate and up-to-date. Examples of these categories of information are located on the Texas Vendor Drug Program website:

http://www.txvendordrug.com/dur/edits.shtml

CFHP maintains prior authorization for Clinical Administered Drugs (CAD) criteria. Below is the criteria for CAD drugs authorizations:

Pharmacy Prior Authorizations

Authorization Requirements - STAR Kids - Effective November 1, 2016

Authorization Requirements - STAR, CHIP, HMO, Exchange - Effective January 1, 2016

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

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Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

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Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347