STAR Medicaid Pharmacy & Drugs
FirstCare STAR members can access prescriptions through any pharmacy that is contracted with Navitus Health Solutions. Navitus administers prescription benefits for FirstCare STAR Members. For pharmacy questions, contact Customer Service at 1-877-639-2447.
You can view your pharmacy directory using the links below:
Formulary
FirstCare uses the state mandated STAR formulary. The formulary is available on the
Texas Medicaid Drug Vendor Drug Program website.
The Texas STAR Formulary is available in paper form without charge. To request a copy, please call FirstCare STAR Customer Service at
1-800-431-7798.
Prior Authorizations
To obtain a prior authorization, providers should call Navitus at 1-877-908-6023. For a listing of clinical edits implemented by FirstCare please
click here, and for access to FirstCare's prior authorization forms please
click here.
- Download the State of Texas Standard Prior Authorization Form.
- If your doctor cannot be reached to approve a prescription, you can get a three-day emergency supply of your medication. Call FirstCare at 1-806-784-4300 for help with your medications and refills.
Member Forms
Prescription Mail Order Form
Prescription Mail Order Form (Spanish)
News
Change in Preferred Drug List Status for the Smoking Cessation Drug Class Effective May 16, 2023 For additional information,
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HHSC to Implement Clinical Prior Authorization for Gattex on June 6, 2023 For additional information,
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HHSC to Implement Clinical Prior Authorization for Antimigraine Agents-Ergot Derivatives on June 6, 2023 For additional information,
click here.
Members Sought for the Drug Utilization Review Board For additional information,
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HHSC to Revise Qulipta Criteria for Clinical Prior Authorization on June 27, 2023 For additional information,
click here.
HHSC to Implement Sotyktu Criteria in Cytokine and CAM Antagonists Clinical Prior Authorization on July 27, 2023 For additional information,
click here.
HHSC to Implement Pulmonary Hypertension Agents Clinical Prior Authorization on July 27, 2023 For additional information,
click here.
Preferred Mavyret for Hepatitis C Infection Treatment and Change to Quantity Limit for Hepatitis C Medications
05/11/2023 Background:
HHSC published the notice “Preferred Mavyret for Hepatitis C Infection Treatment and Change to Quantity Limit for Hepatitis C Medications” on May 1, 2023.
Key Details:
This update is to clarify the following notice regarding the quantity limit change for Hepatitis C infection treatment. The quantity limit change in this notice applies to all Hepatitis C DAA medications, not just the NDCs listed in the table below.
Quantity Limit Change
HHSC intends this initiative to increase awareness, screening, diagnosis, and treatment for Medicaid clients. HHSC will help improve access and adherence by allowing prescribers to write prescriptions for the entire course of therapy so clients will no longer need to request additional refills throughout their treatment duration. Prescribers may choose to write a prescription for the entire treatment cycle or have the client return for further testing if warranted. This change applies to all Hepatitis C DAA medications.
By May 25, 2023, MCOs must update pharmacy quantity supply limits and maximum day supply coverage on DAA medications to allow access to the entire course of therapy. Prescribers may identify some clients needing to take the medication longer than others. MCOs may allow longer treatment duration upon prescriber request. MCOs must inform their providers and members of this change.
Reminder
All Medicaid clients are eligible for DAA treatment with the primary preferred agent regardless of the client’s METAVIR fibrosis score, and prior authorization is not required. Any enrolled Medicaid provider can prescribe the preferred drug, and HHSC does not require a drug screening. The table below summarizes the national drug codes (NDCs) impacted by the PDL change:
| Drug Name |
NDC |
Jan 1, 2023 PDL status |
| Mavyret |
00074260028
00074262528 |
Preferred |
| Epclusa |
61958220101
61958220301
61958220401
61958220402
61958220501
61958220502 |
Non-Preferred |
| Vosevi |
61958240101 |
Non-Preferred |
HHSC published an update to the Texas Medicaid Preferred Drug List (PDL) on Jan. 1, 2023, designating the preferred and non-preferred options for DAA treatment. HHSC also included the changes in the daily PDL file delivered to managed care plans via TXMedConnect. PDL statuses were future-dated to reflect the Jan. 1 changes.
HHSC did not change the PDL status for all other non-preferred DAA drugs currently on the formulary. For any non-preferred DAA drugs, HHSC will continue to apply PDL prior authorization criteria for all Medicaid clients, both fee-for-service and managed care.
HHSC asks MCOs to continue to remind their providers and members regarding the availability of Hepatitis C treatment coverage.
Contact: vdp-operations@hhsc.state.tx.us
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HHSC Removed Monovalent Moderna and Pfizer-BioNTech COVID-19 Vaccines From Formulary on April 21, 2023 For additional information,
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HHSC to Update Hereditary Angioedema Clinical Prior Authorization For Fee-For-Service on May 23, 2023 For additional information,
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HHSC to Update Anxiolytics and Sedative-Hypnotics Clinical Prior Authorization For Fee-For-Service on June 22, 2023 For additional information,
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Jan. 2023 Preferred Drug List Decisions Now Available For additional information,
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Update to "HHSC To Implement Clinical Prior Authorizations For Fee-For-Service" For additional information,
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Pharmacy Email Addresses Must Be Current in PEMS For additional information,
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Clinical Prior Authorization Assistance Chart Now Available For additional information,
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Memorial Day Holiday to Delay Pharmacy Payments For additional information,
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HHSC to Revise Opiate/Benzodiazepine/Muscle Relaxant Combinations Prior Authorization For additional information,
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Summary of April 2023 Drug Utilization Review Board Meeting Now Available For additional information,
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HHSC To Update Opioid Product Information in Clinical Prior Authorizations for Medicaid Fee-for-Service For additional information,
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April 2023 NDC-to-HCPCS Crosswalk Now Available For additional information,
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Revised VDP Manuals Available For additional information,
click here.
CSHCN Removes Remodulin From Formulary As Of April 17, 2023 For additional information,
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CSHCN To Remove Multiple Drugs From Formulary on June 1, 2023 For additional information,
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Age Expansion Indication for Cibinqo Clinical Prior Authorization Criteria Effective May 31, 2023 For additional information,
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Update to Livmarli Clinical Prior Authorization Criteria Effective May 30, 2023 For additional information,
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Makena Products No Longer Covered As Of April 7, 2023 For additional information,
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Agenda for April Drug Utilization Review Board Meeting Now Available For additional information,
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Texas State Plan Public Notice of Intent for Waiver of Drug Counseling Signature Requirements For additional information,
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March 2023 Specialty Drug List AvailableFor additional information,
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Hereditary Angioedema Agents Clinical Prior Authorization Effective for Medicaid Fee-for-Service on April 11, 2023For additional information,
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HHSC to Implement Enzymes Clinical Prior Authorization for Medicaid Fee-for-Service on April 18, 2023For additional information,
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Temporary Change in PDL Status for the Neuropathic Pain Drug Class Effective April 3, 2023For additional information,
click here.
Pharmacy Education Information and OpportunitiesFor additional information,
click here.
Revisions of Antimigraine Agents (Triptans) Clinical Prior Authorization Criteria Scheduled for April 5, 2023 (Revised) For additional information,
click here.
Implementation of Inhaled Antibiotics Clinical Prior Authorization for Medicaid Fee-For-Service Set for May 2, 2023 For additional information,
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HHSC To Implement Multiple Clinical Prior Authorizations For Fee-For-Service For additional information,
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Pharmacy Resolution Help Desk Down Due To Statewide Outages For additional information,
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Extended Database Maintenance For Pharmacy Claims Vendor Weekend of March 18, 2023 For additional information,
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Draft Specialty Drug List Available for Comment, Responses Due March 17, 2023 For additional information,
click here.
Clinical Prior Authorization Criteria for Calcitonin Gene-Related Peptide Receptor Antagonists Effective April 4, 2023 For additional information,
click here.
Revised VDP Manuals Available For additional information,
click here.
Revision of Olumiant Clinical Prior Authorization Criteria Scheduled for March 27, 2023 For additional information,
click here.
Revisions of Antimigraine Agents (Triptans) Clinical Prior Authorization Criteria Scheduled for April 4, 2023 For additional information,
click here.
Respiratory Syncytial Virus (RSV) Season Ends on March 1, 2023 For additional information,
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2022-23 RSV Season Schedule For additional information,
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January 2023 Drug Utilization Review Board Meeting For additional information,
click here.
Clinical Prior Authorization Assistance Chart Now Available For additional information,
click here.
January 2023 Preferred Drug List Updated For additional information,
click here.
Changes to Lovaza Clinical Prior Authorization Scheduled for March 21, 2023 For additional information,
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January 2023 NDC-to-HCPCS Crosswalk Now Available For additional information,
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Changes in Hepatitis C Treatment Coverage for Medicaid Clients Begins Jan. 1, 2023 For additional information,
click here.
Clinical Prior Authorization Criteria Changes Scheduled for Feb. 7, 2023 For additional information,
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Androgenic Agents Clinical Prior Authorization Criteria Revision Scheduled for Feb. 1, 2023 For additional information,
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Younger Age Groups Now Eligible For Updated Bivalent COVID-19 Vaccines For additional information,
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July 2022 Preferred Drug List Updated For additional information,
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Pharmacy Education Information and Opportunities For additional information,
click here.
NDC Requirements for the Submission of Clinician-Administered Drug Claims For additional information,
click here.
Revised VDP Manuals Available For additional information,
click here.
Agenda for January Drug Utilization Review Board Meeting Now Available For additional information,
click here.
Retroactive Claim Form Process Ending Dec. 31, 2022 For additional information,
click here.
Revised VDP Manuals Available For additional information,
click here.
Clinical Prior Authorization for Calcitonin Gene-Related Peptide Receptor (CGRP) Antagonists in Traditional Medicaid Begins Dec. 30, 2022 For additional information,
click here.
Genabio COVID-19 At-Home Test Kit Added to Formulary For additional information,
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Semi-annual Medicaid Preferred Drug List Update Coming Jan. 26, 2023 For additional information,
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Hepatitis C Treatment Coverage and PDL Update Scheduled for Jan. 1, 2023 For additional information,
click here.
Manufacturer Reminder For Properly Submitting Rebate Invoices For additional information,
click here.
Clinical Prior Authorization Assistance Chart Now Available For additional information,
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Input on Proposed Medicaid, CHIP Formulary, PDL and Prior Authorization Management Transition Policy Due Dec. 4, 2022 For additional information,
click here.
Revised VDP Manuals Available For additional information,
click here.
October 2022 Drug Utilization Review Board Meeting Summary For additional information,
click here.
New Report from HHSC For additional information,
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CGRP Antagonist Prophylaxis Prior Authorization Revisions Scheduled for Nov. 22, 2022 For additional information,
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Revision to Cosentyx Clinical Prior Authorization Criteria Scheduled for Nov. 22, 2022 For additional information,
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October 2022 NDC-to-HCPCS Crosswalk Now Available For additional information,
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Clinical Prior Authorization Criteria Revisions for Bylvay Scheduled for Nov. 21, 2022 For additional information,
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July 2022 Preferred Drug List Decisions Now Available For additional information,
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Clinical Criteria Update for Orkambi Scheduled for Nov. 9, 2022 For additional information,
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Summer 2022 RSV Season Schedule For additional information,
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RSV Fall/Winter Traditional Season Regional Changes Effective Oct. 17, 2022 For additional information,
click here.
2022-23 RSV Season Schedule For additional information,
click here.
ProAir HFA Inhaler Discontinuation For additional information,
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Revised VDP Manuals Available For additional information,
click here.
Pharmacy Education Reminder For additional information,
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Agenda for October Drug Utilization Review Board Meeting Now Available For additional information,
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PDL Prior Authorization Criteria Revisions Scheduled For Oct. 11, 2022 For additional information,
click here.
Criteria Changes for Subsequent Dosing of Palivizumab (Synagis) with Fall/Winter Traditional Respiratory Syncytial Virus Season For additional information,
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Temporary Change in PDL Status for Clonidine Transdermal Patches Effective Sept. 26, 2022 For additional information,
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Clinical Prior Authorization Criteria Revisions Implement for Medicaid Fee-for-Service On Oct. 26, 2022 For additional information,
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September 2022 Specialty Drug List Available For additional information,
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Pharmacy Prior Authorization System Maintenance Scheduled for Monday, Oct. 3, 2022 For additional information,
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Psychiatrist Sought for the Drug Utilization Review Board For additional information
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Bivalent Moderna COVID-19 Booster Vaccine Coverage Update For additional information
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Bivalent Pfizer COVID-19 Booster Vaccine Coverage Update For additional information,
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Hepatitis C Treatment Coverage and PDL Update Scheduled for Jan. 1, 2023 For additional information,
click here.
RSV Summer Season Changes Begin Sept. 1, 2022 For additional information,
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Draft Specialty Drug List Available for Comment, Responses Due Sept. 22, 2022 For additional information,
click here.
July 2022 Preferred Drug List Updated For additional information,
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Drug Regimen Optimization Clinical Prior Authorization to Retire Sept. 12, 2022 For additional information
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Clinical Prior Authorization Assistance Chart Now Available For additional information,
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Clinical Prior Authorization for Xenical No Longer Required After Sept. 12, 2022 For additional information,
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Hepatitis C Treatment Coverage and PDL Update Scheduled for Sept. 1, 2022 For additional information,
click here.
July 2022 Preferred Drug List Now Available For additional information
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Revised VDP Manuals Available For additional information
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July 2022 Drug Utilization Review Board Meeting Summary For additional information
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EXTENDED: Members Sought for the Drug Utilization Review Board until Aug. 1, 2022 For additional information
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July 2022 NDC-to-HCPCS Crosswalk Now Available For additional information
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Novavax COVID-19 Vaccine Coverage Update For additional information
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Prior Authorization Criteria Update for Rinvoq and Cibinqo For additional information
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Semi-annual Medicaid Preferred Drug List Update Coming July 28, 2022 For additional information
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April 2022 Preferred Drug List Decisions Now Available For additional information
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Revised Application for Texas Identification Number Now Available for Pharmacy Enrollment For additional information
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HHSC Pharmacy Prior Authorization System Maintenance Scheduled for Early Morning This Wednesday For additional information
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HHSC to Reject Pharmacy Claims for Inaccurate License Information Beginning Sept. 28, 2022 For additional information
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Agenda for July Drug Utilization Review Board Meeting Now Available For additional information
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Revised VDP Manuals Available For additional information
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Clinical Prior Authorization Criteria Updates for Dupixent, Evrysdi, and Qelbree For additional information
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Pediatric Updates for Moderna & Pfizer-BioNTech COVID-19 Vaccines For additional information
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Medicare Part B and D Indicators Available on Formulary Searches Beginning June 6, 2022 For additional information
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EXTENDED: Members Sought for the Drug Utilization Review Board until July 1, 2022 For additional information
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COVID-19 Drug Veklury (Remdesivir) Update For additional information,
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Clinical Prior Authorization Assistance Chart Now Available For additional information,
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Summer 2022 RSV Season Schedule For additional information,
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Pfizer COVID-19 Vaccine Booster Dose for Children Update For additional information,
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Moderna COVID-19 Vaccine Booster Dose Update For additional information,
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Respiratory Syncytial Virus (RSV) Prophylaxis Season Reopening Across All Regions For additional information,
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Changes for Client Access to Mosquito Repellent Benefit Begin June 1, 2022 For additional information,
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Spikevax COVID-19 Vaccine Coverage Update For additional information,
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Members Sought for the Drug Utilization Review Board For additional information
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Changes for Client Access to Mosquito Repellent Benefit Begin June 1, 2022 For additional information
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Update to the Pharmacy Procedure Manual Now Available For additional information
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Second COVID-19 Vaccine Booster Dose Update For additional information
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Request for Pharmacies to Check That Pharmacy Licenses Are Current in PEMS For additional information
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April 2022 Drug Utilization Review Board Meeting Summary For additional information
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Revision to Makena Authorization Request Form Scheduled for June 10, 2022 For additional information
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January 2022 Preferred Drug List Decisions Now Available For additional information
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Update to the Pharmacy Procedure Manual Now Available For additional information
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March 2022 Specialty Drug List Available For additional information
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Agenda for April Drug Utilization Review Board Meeting Now Available For additional information
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Pharmacy Education Reminder For additional information
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Changes for Client Access to Mosquito Repellent Benefit Begin June 1, 2022 For additional information
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Draft Specialty Drug List Available for Comment For additional information .
Updates to Phosphate Binder Prior Authorization Criteria Scheduled for April 5, 2022 For additional information
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Cytokine and CAM Antagonists Criteria Updates Scheduled for April 5, 2022 For additional information
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Oxbryta Prior Authorization Criteria Updates Scheduled for April 5, 2022 For additional information
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January 2022 Drug Utilization Review Board Meeting Summary For additional information
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Clinical Prior Authorization Assistance Chart Now Available For additional information
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2021-22 Respiratory Syncytial Virus (RSV) Season Ends February 1, 2022 For additional information
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January 2022 Preferred Drug List Now Available For additional information
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Temporary Change in PDL Status for Tetracyclines Drug Class, Effective January 11, 2022 For additional information
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Pfizer-BioNTech COVID-19 Booster Update For additional information
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November 2021 Preferred Drug List Decisions Now Available For additional information
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Pfizer-BioNTech COVID-19 Vaccine Booster Dose Age Change and New Formulation For additional information
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Agenda for January Drug Utilization Review Board Meeting Now Available For additional information
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Managed Care Resources Update For additional information
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COVID-19 At-home Test Kits Available as a Pharmacy Benefit For additional information
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Pfizer Oral COVID-19 Drug, Paxlovid, Added to Formulary For additional information
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Medicaid Pharmacy Benefit Accredited Course, Quick Courses Available For additional information
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You Can Report Drug Shortages to HHSC For additional information
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Merck Oral COVID-19 drug, Molnupiravir, Added to Formulary For additional information
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Change in Age Limit for Pharmacist-Administered Influenza Vaccines For additional information
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Kidney Health Care Adds New Drugs to Formulary For additional information
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COVID-19 Vaccine Booster Update For additional information
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Semi-annual Medicaid Preferred Drug List Update Coming January 27, 2022 For additional information
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Draft of Medication Therapy Management Policy Available for Comment For additional information .
Stimate Nasal Spray National Drug Shortage For additional information
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Pharmacy Services Change of Ownership (CHOW) Interim Process For additional information
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Promethazine Clinical Prior Authorization Criteria Updates Scheduled for December 7, 2021 For additional information
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Dupixent Clinical Prior Authorization Criteria Update Scheduled for January 4, 2022 For additional information
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Clinical Prior Authorization Assistance Chart Now Available For additional information
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November 2021 Drug Utilization Review Board Meeting Summary For additional information
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July 2021 Preferred Drug List Revised December 3, 2021 For additional information
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Removal of Specialist Requirement from Clinical Prior Authorization Criteria Scheduled for January 3, 2022 For additional information
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Agenda for November Drug Utilization Review Board Meeting Now Available For additional information
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Order and Administration of Selected COVID-19 Monoclonal Antibody Therapeutics Reimbursable Through Medicaid Medical Claims System For additional information
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COVID-19 Vaccine Coverage Update: Comirnaty and Pfizer Age Change For additional information
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Removal of Specialist Requirement from Clinical Prior Authorization Criteria Scheduled for January 3, 2021 For additional information
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Coverage of COVID-19 Booster Doses of Moderna and Johnson & Johnson Vaccines For additional information
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October 2021 NDC-to-HCPCS Crosswalk Now Available For additional information
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Updates to Medicaid Preferred Drug List Scheduled for November 15, 2021 For additional information
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Pharmacy Submittal of COVID-19 Vaccine Additional, Booster Doses For additional information
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Nucala Clinical Prior Authorization Update Scheduled for December 14, 2021 For additional information
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Repatha (evolocumab) Prior Authorization Update Scheduled for December 6, 2021 For additional information
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Hepatitis C Drug Rebate Program Procurement Information Now Available For additional information
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HHSC Updates Respiratory Syncytial Virus (RSV) Season Schedule For additional information
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HHSC Issues Stromectol (Ivermectin) Guidance For additional information
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Temporary Change in Texas Pharmacy Prior Authorization Call Center Phone Number For additional information
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Alinia Clinical Prior Authorization Criteria Revision Effective November 23, 2021 For additional information
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Updating Pharmacy Claim Systems for COVID-19 Vaccine Additional Doses For additional information
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2021-22 RSV Assessment and Synagis Authorization For additional information
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Changes to Hepatitis C Prior Authorization Criteria Begin September 1, 2021 For additional information
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Duplicate Therapy Clinical Prior Authorization Criteria Revision Begins October 19, 2021 For additional information
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Respiratory Syncytial Virus and Synagis Authorization During Summer and Winter 2021-2022 For additional information
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July 2021 Drug Utilization Review Board Meeting Summary For additional information
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Atypical Respiratory Syncytial Virus (RSV) Season Advisory For additional information
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April 2021 Preferred Drug List Decisions Now Available For additional information
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July 2021 Preferred Drug List Now Available For additional information
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Changes to Hepatitis C Prior Authorization Criteria Begin September 1, 2021 For additional information
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Trikafta Age Expansion in Cystic Fibrosis Agents Clinical Prior Authorization Begins September 1, 2021 For additional information
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Nucala Clinical Prior Authorization Criteria Update Begins July 12, 2021 For additional information
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Semi-annual Medicaid Preferred Drug List Update Coming July 29, 2021 For additional information
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HHSC to Reopen RSV Season in Select Regions on June 21, 2021 For additional information
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Medicaid Allows Pfizer BioNTech COVID-19 Vaccine for Emergency Use in Adolescents For additional information
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HHSC to Resume Quarterly Specialty Drug List in July 2021 For additional information
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COVID-19 Testing in Pharmacy Reimbursable Through Medicaid Medical Claims System For additional information
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Clinical Prior Authorization Assistance Chart Now Available For additional information
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April 2021 Preferred Drug List Recommendations Now Available For additional information
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COVID-19 Vaccine Administration Rate Change Effective April 1, 2021 For additional information
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January 2021 Preferred Drug List Decisions Now Available For additional information
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Enzymes Clinical Prior Authorization Criteria Revisions Effective June 30, 2021 For additional information
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Frequently Asked Questions about the Medicaid Standing Order for Mosquito Repellent For additional information
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Epidiolex Prior Authorization Revision Scheduled for May 11, 2021 For additional information
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Medicaid Adds Johnson & Johnson COVID-19 Vaccine to Formulary For additional information
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Revised Hepatitis C Drug Prior Authorization Form 1342 For additional information
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January 2021 Preferred Drug List Revised March 5, 2021 For additional information
click here.
Revisions to Cytokine and CAM Antagonists Prior Authorization Criteria Set for May 4, 2021 For additional information
click here.
RSV Season Extended for Counties in Southeast Texas and Gulf Coast Areas For additional information
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Monoclonal Antibody for Asthma Prior Authorization Updates Set for April 6, 2021 For additional information
click here.
Revised Hepatitis C Drug Prior Authorization Forms Now Available For additional information
click here.
Clinical Prior Authorization Updates for Cystic Fibrosis Agents For additional information
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Preferred Drug List Criteria Exception for Macrolides Changes March 15 For additional information
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Renewed Texas Standing Order for Mosquito Repellent Benefit Available For additional information
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Clinical Prior Authorization Assistance Chart Now Available For additional information
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January 2021 Preferred Drug List Now Available For additional information
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Desmopressin Clinical Prior Authorization Revision Begins March 15, 2021 For additional information
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COVID-19 Vaccine NDC Update For additional information
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Dupixent Clinical Prior Authorization Criteria Revision Effective March 15, 2021 For additional information
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Change to Thiazolidinediones Clinical Prior Authorization Begins February 4, 2021 For additional information
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Medicaid Adds Moderna COVID-19 Vaccine to Formulary For additional information
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Medicaid Adds Pfizer BioNTech COVID-19 Vaccine to Formulary For additional information
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July 2020 Preferred Drug List Revised Dec. 16 For additional information
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Semi-annual Medicaid Preferred Drug List Update Coming Jan. 28, 2021 Preferred drugs are medications recommended by the Texas Drug Utilization Review Board. The Texas Preferred Drug List is published every January and July. For additional information click here.