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class="top-content-wrapper"> <div class="content-wrapper"> <div class="document-header"> <h1 data-epi-type="title">Pharmacy Information</h1> </div> <div class="content-area" data-epi-type="content"> <div class="right-content"> <div class="score-accordion section-menu-wrapper"> <div class="score-accordion-panel"> <div class="panel-heading"> <div class="panel-title"> <button type="button" class="accordion-button" data-target="#sectionMenu" aria-expanded="false" aria-controls="accordion1"> In This Section </button> </div> </div><div id="sectionMenu" class="panel-collapse collapse"> <div class="panel-body"> <div class="bg-lightgrey"> <ul class="main"> <li class=""> <a href="/providers/" aria-label="For Providers" class="GTMMENU" target="_self"> For Providers </a> </li> </ul> <ul class="level-1"> <li class=""> <a href="/providers/behavioral-health-services/" aria-label="Behavioral Health Services" class="GTMMENU" target="_self"> Behavioral Health Services </a> </li> <li class=""> <a href="/providers/complaints-and-appeals/" aria-label="Complaints and Appeals" class="GTMMENU" target="_self"> Complaints and Appeals </a> </li> <li class=""> <a href="/providers/electronic-submission-services/" aria-label="Electronic Submission Services" class="GTMMENU" target="_self"> Electronic Submission Services </a> </li> <li class=""> <a href="/providers/electronic-visit-verification/" aria-label="Electronic Visit Verification" class="GTMMENU" target="_self"> Electronic Visit Verification </a> </li> <li class=""> <a href="https://www.cookchildrens.org/healthcare-professionals/professional-education/grand-rounds-video-library/" aria-label="Grand Rounds Video Library" class="GTMMENU" target="_self"> Grand Rounds Video Library </a> </li> <li class=""> <a href="/providers/provider-hhsc-news/" aria-label="HHSC News" class="GTMMENU" target="_self"> HHSC News </a> </li> <li class=""> <a href="/providers/joining-the-network/" aria-label="Joining the Network" class="GTMMENU" target="_self"> Joining the Network </a> </li> <li class=""> <a href="/providers/long-term-services-and-support/" aria-label="Long Term Services and Supports" class="GTMMENU" target="_self"> Long Term Services and Supports </a> </li> <li class=""> <a href="/providers/provider-manual-and-forms/" aria-label="Manuals and Forms" class="GTMMENU" target="_self"> Manuals and Forms </a> </li> <li class="active"> <a href="/providers/pharmacy-information/" aria-label="Pharmacy Information" class="GTMMENU" target="_self"> Pharmacy Information </a> </li> <li class=""> <a href="/providers/prior-authorization-search/" aria-label="Prior Authorization" class="GTMMENU" target="_self"> Prior Authorization </a> </li> <li class=""> <a href="/providers/Private-Duty-Nursing/" aria-label="Private Duty Nursing" class="GTMMENU" target="_self"> Private Duty Nursing </a> </li> <li class=""> <a href="/providers/provider-news/" aria-label="Provider News" class="GTMMENU" target="_self"> Provider News </a> </li> <li class=""> <a href="/providers/provider-relations/" aria-label="Provider Relations" class="GTMMENU" target="_self"> Provider Relations </a> </li> <li class=""> <a href="/providers/quality-improvement/" aria-label="Quality Improvement" class="GTMMENU" target="_self"> Quality Improvement </a> </li> <li class=""> <a href="/providers/resources/" aria-label="Resources" class="GTMMENU" target="_self"> Resources </a> </li> <li class=""> <a href="https://epiccarelink.cookchp.org/LinkHealthPlan/common/epic_login.asp" aria-label="Secure Provider Portal" class="GTMMENU" target="_self"> Secure Provider Portal </a> </li> <li class=""> <a href="/providers/texas-health-steps/" aria-label="Texas Health Steps" class="GTMMENU" target="_self"> Texas Health Steps </a> </li> <li class=""> <a href="/providers/therapy-information/" aria-label="Therapy Information" class="GTMMENU" target="_self"> Therapy Information </a> </li> </ul> </div> </div> </div> </div> </div> </div> <div class="top-content"> <div class="rte-content"> <div class="rich-text"><p>Cook Children's Health Plan uses Navitus Health Solutions as their Pharmacy Benefit Manager (PBM).</p> <h2>Please visit the Navitus website for the following pharmacy information:</h2> <ul> <li><a href="http://txstarchip.navitus.com/clinicaledits" target="_blank" rel="noopener">Clinical edits</a></li> <li><a href="http://txstarchip.navitus.com/formulary" target="_blank" rel="noopener">Formulary</a></li> <li><a href="http://txstarchip.navitus.com/pharmacyinformation" target="_blank" rel="noopener">Pharmacy directory</a></li> <li><a href="http://txstarchip.navitus.com/priorauthorizationforms" target="_blank" rel="noopener">Prior authorization forms</a></li> <li><a href="https://www.navitus.com/drug-recalls" target="_blank" rel="noopener">Drug recalls</a></li> <li><a href="https://pharmacies.navitus.com/Secured-Pages/Nav/Resources/MAC-Program.aspx" target="_blank" rel="noopener">Maximum allowable cost</a></li> </ul> <h2>Navitus Provider Relations can assist you with:</h2> <ul> <li>Network participation</li> <li>Network access reports</li> <li>Contract questions</li> <li>Pharmacy credential review</li> <li>Reimbursement and remittances</li> <li>Maximum allowable cost list (MAC)</li> <li>Network system set up</li> <li>Pharmacy performance analysis and reporting</li> <li>Pharmacy communications</li> </ul> <h2>Providers can contact Navitus at:</h2> <ul> <li>Pharmacy Provider Relations/Contacts: <a style="text-decoration: none;" title="1-866-333-2757" href="tel:1-866-333-2757">1-866-333-2757</a></li> <li>Fax: 1-866-808-4649</li> <li>Email: <a title="Email" href="mailto:providerrelations@navitus.com">providerrelations@navitus.com</a></li> <li>Navitus Texas Provider Hotline: <a style="text-decoration: none;" title="providerrelations@navitus.com" href="tel:1-877-908-6023">1-877-908-6023</a> (toll free)</li> <li>Prior authorization: <a style="text-decoration: none;" title="1-877-908-6023" href="tel:1-877-908-6023">1-877-908-6023</a> (toll free)</li> <li>Pharmacy network (request a contract, 835 setup, remit issues): <a style="text-decoration: none;" title="1-608-729-1577" href="tel:1-608-729-1577">1-608-729-1577</a></li> <li>Fraud, Waste, and Abuse: <a style="text-decoration: none;" title="1-855-673-6503" href="tel:1-855-673-6503">1-855-673-6503</a></li> </ul> <h2><a title="Vendor Drug Program" href="https://www.txvendordrug.com/" target="_blank" rel="noopener">Vendor Drug Program</a></h2> <p>The Texas Medicaid formulary is updated regularly by the Vendor Drug Program located on txvendordrug.com.</p> <ul> <li><a title="Formulary Drug Search" href="https://www.txvendordrug.com/formulary/formulary-search" target="_blank" rel="noopener">Formulary drug search</a></li> <li><a title="Preferred Drug List Criteria Guide" href="https://www.txvendordrug.com/resources/downloads">Preferred drug list criteria guide</a></li> <li><a title="Clinical Prior Authorizations" href="https://www.txvendordrug.com/formulary/clinical-prior-authorizations-managed-care" target="_blank" rel="noopener">Clinical prior authorizations</a></li> <li><a title="Clinical Prior Authorization Assistance Chart" href="https://www.txvendordrug.com/sites/default/files/docs/cpa-assistance-chart.pdf" target="_blank" rel="noopener">Clinical prior authorization assistance chart</a></li> <li><a title="Epocrates" href="https://www.epocrates.com/">Epocrates</a> <ul> <li>A free subscription drug information service that can be downloaded to a computer or handheld device</li> <li>In addiition to listing a drug's preferred status, Epocrates includes drug monographs, dosing information, and warnings. All prescribing Providers are eligible to register for Epocrates online</li> </ul> </li> </ul> <p><span style="color: rgba(84,88,89,var(--tw-text-opacity)); font-size: 2rem; font-weight: inherit;">Clinician Administered Drugs</span></p> <p>Medicaid Services Program may reimburse Providers only for <a href="/siteassets/documents/cad.pdf" target="_blank" rel="noopener">Clinician-administered drugs</a> and biologicals whose manufacturers participate in the Centers for Medicare and Medicaid Services (CMS) Drug Rebate Program and that show as active on the CMS list for the date of service the drug is administered. Clinician-administered drugs that do not have a rebate-eligible National Drug Code (NDC) will not be reimbursed by Texas Medicaid Program. Please note there may be ingredients in a compound that are not considered a drug under the Federal Food, Drug, and Cosmetic Act.</p></div> </div> <div class="score-accordion " id="4c8476ee-8894-43ab-b838-4254c35badd4"> <div class="score-accordion-panel "> <div class="panel-heading"> <h3 id="f3edcf95-560d-4793-ae00-d51c29907ef1-title" class="panel-title"> <button type="button" class="accordion-button GTMBUTTON" data-target="#f3edcf95-560d-4793-ae00-d51c29907ef1-panel" aria-expanded="false" aria-controls="f3edcf95-560d-4793-ae00-d51c29907ef1-panel"> Clinician Administered Drugs </button> </h3> </div> <div id="f3edcf95-560d-4793-ae00-d51c29907ef1-panel" class="panel-collapse collapse "> <div class="panel-body"> <div class="rich-text"> <h4> </h4> <div class="rich-text"><ul> <li><a title="July 2024 Clinician Administered Drug" href="/siteassets/documents/pdfs/pharmacy-informatiom/july-2024-clinician-administered-drug.pdf" target="_blank" rel="noopener">Clinician Administered Drugs</a></li> 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