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About RightCare

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Here’s your go-to guide for RightCare

Filled with useful information, your member handbook helps you get the care you need. Read through to learn all about your benefits. It’s pretty handy to have, especially if you don’t always have Internet access. Inside you’ll find:

Download RightCare Member Handbook

RightCare Member Handbook Table of Contents

About Notifications and Prior Authorizations

STAR Medicaid Terms and Definitions

If you need this book in a different format such as audio, large print, braille, or in a language other than English and Spanish, call RightCare Member Services.

Call RightCare at 1-855-897-4448 to get paper copies of helpful information:

  • • Member Handbook
  • • Provider Directory
  • • Privacy Practices
  • • Members Rights & Responsibilities
  • • Anything on our website
This information will be sent at no cost to you within five (5) business days.

Texas Health and Human Service - Texas STAR

Member Information

Scott and White Health Plan for RightCare — RightCare from Scott and White Health Plan is part of Baylor Scott & White Health, a healthcare system in West, Central and North Texas. In 2022, many members of Scott and White Health Plan will have a new brand on their plan materials: Baylor Scott & White Health Plan. RightCare members, like you, will not see a new brand on your materials in 2022. Your plan will continue under the Scott and White Health Plan name. Questions? Call us at 1.855.TX.RIGHT (1.855.897.4448) TTY: 711, Monday through Friday from 7 AM to 7 PM.

NEW Chat with Customer Service

Need a Ride? Nonemergency Medical Transportation (NEMT) — Starting June 1, 2021, we can help you or your child get a ride, at no cost, to the doctor, hospital, dentist, and drugstore.

Nondiscrimination Notice

Replacement ID Card — If you lose your RightCare STAR Medicaid ID Card, call us right away at 1-855-897-4448 to get a new one. If you don’t have the card, you can still go to the doctor, clinic, or hospital. You might have to wait for services while your RightCare membership is checked.

Member Rights and Responsibilities

Texas Medicaid for Children — 1-877-847-8377 (1-877-THSteps)

Notice of Privacy Practices — For information on how medical information about you may be used and disclosed and how you can get access to this information use the Notice of Privacy Practices.

New website for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) at texaswic.org

The website includes features such as online nutrition classes, recipes, and a newsletter feature that provides parents with customized information based on the child's current age for children ages 1-5. Parents can subscribe to the newsletter here for information in English and here for information in Spanish.

Join Texas WIC

Frequently Asked Questions about Medicaid Transition

I received a letter that my Medicaid changed (or may change), what does this mean?

  • Starting February 2021, the Texas Health and Human Services Commission (HHSC) will transition Medicaid clients to the appropriate type of Medicaid coverage on an ongoing basis when there is an identified change in circumstance.
  • If HHSC receives information that your household has a change in circumstances (such as income, expenses, people in the household, etc.) they will move you to the appropriate type of Medicaid coverage based on the eligibility criteria your household meets.
  • This does not necessarily mean you will have a reduction in coverage.
  • Review the notice for any requests to take action. If the letter is asking for you to take any action, please comply with this request as soon as possible.

I received a letter that I need to select a new health plan, what does this mean?

If you received an actual enrollment form or alert via text/E-mail to select a new plan HHSC will send you either a separate enrollment form if it is determined that you need to pick a new health plan. If this is necessary, you should receive this request within 15 calendar days of the date on the TF0001 Notice about your case.

You received notice to select a new health plan.

  • HHSC has determined that your new Medicaid program requires you to pick a health plan.
  • If you know what plan you want to pick, go ahead and do so and return the form.
  • If you need further assistance, HHSC Managed Care can assist. Managed Care hours of operations are 8 a.m. - 6 p.m. Central Time, Monday through Friday.

What might make HHSC change my type of Medicaid?

  • HHSC looks at the following information to determine what the appropriate type of Medicaid is for the client:
  • Renewal applications.
  • Reported changes.
  • Information received from other agencies, such as the Social Security Administration.

Will I continue to keep my Medicaid during COVID?

  • Yes, Medicaid coverage will continue for anyone who has coverage during the federal declared public health emergency.
  • The only exceptions could be:
  • Clients who move out of Texas.
  • Clients who voluntarily leave/withdraw from Medicaid.
  • Deceased clients.

However, if you have received a notice that you are no longer eligible for Medicaid, your coverage may end at the end of the public health emergency.

  • Clients may receive notice on their TF0001 that their Medicaid eligibility/coverage will end with the public health emergency ends.
  • This will happen for one of the following reasons:
  • The household failed to respond to a request from HHSC like a renewal packet or H1020 Request for Missing Information, or
  • HHSC received information via a renewal packet, reported change, or from another agency that indicates the household no longer meets the eligibility requirements.

Could my Medicaid or Health Plan change during COVID?

  • Yes, If HHSC receives information that a client no longer meets the criteria for their current type of Medicaid coverage, but
  • DOES meet the criteria for a different type of Medicaid coverage, they will be moved to that type of Medicaid coverage, if it provides the same (or a better) level of coverage.
  • DOES NOT meet the criteria for any other type of Medicaid coverage, they will continue in their same type of Medicaid coverage until the federally-declared public health emergency ends or federal guidance changes.
  • The only exceptions are Healthy Texas Women (HTW), Community Attendant Services (CAS), and CHIP.
  • Medicaid clients will not be transitioned to any of these programs from another health care program during the public health emergency.

HHSC Notification Area

  • Healthy Texas Women Plus — Beginning Sept. 1, 2020, Texas HHSC is implementing Healthy Texas Women Plus (HTW Plus), an enhanced, cost-effective and limited postpartum services package for women in the HTW program. HTW Plus will be provided in the postpartum period for not more than 12 months after the start date. Women in HTW Plus will have access to both HTW and HTW Plus benefits. Learn more.
  • Member Fraud Notice

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Provider Directory

  • Members can choose a PCP by calling Member Services at 1-855-897-4448. RightCare’s Provider Directory lists all in-network PCPs. You may ask for one to be mailed to you by calling Member Services at 1-855-897-4448. You may also view the Provider Directory here.
  • Specialty Providers Referrals — Referrals are needed to see most RightCare specialty provider. A referral is an approval from your PCP for you to get specialty care and follow up treatment. If you receive services from a specialist without your PCP’s referral, or if the specialist is not a RightCare provider, you might be responsible for the bill. You can get some services without going to your PCP first. These include:
  • 24-hour Emergency Care (if you feel you have a true medical emergency)
  • Routine Vision Care
  • Dental Services (for children)
  • OB/GYN Care
  • Family Planning Services and Supplies
  • Behavioral (Mental) Health and Substance Abuse Services
  • Texas Health Steps

Medicaid Appeals Process

You can appeal a decision if Medicaid covered services are denied based on lack of medical need.

Complaints Process

If you have a complaint, please call us toll-free at 1-855-897-4448 to tell us about your problem.

File a Complaint

Click here.

Grow WellTM

Grow Well App

Mindoula - Behavioral Health Support

Who qualifies?

Active Scott and White Health Plan STAR members qualify based on certain conditions. Mindoula will reach out to you if you qualify.

How can Mindoula help?

Mindoula is a behavioral health management vendor that provides tech-enabled (digital) 24/7 case/care management and psychiatric support to members with behavioral health challenges and multiple medical needs.

Programs provided by Mindoula and their StrongWell Program:

  • Interpersonal Violence Reduction Program (IVRP)
  • Suicide Prevention Program (SPP)
  • SUD (Substance Use Disorder) Exposed Pregnancy (SEPP)
  • Substance Exposed Living Program (SELP)

Papa Pals - Extra Support for New Moms

Who qualifies?

Papa Pals is for active Scott and White Health Plan STAR members from birth to one year of age and pregnant STAR members. You can receive up to 120 hours of service per year.

How can Papa Pals help?

  • Social support
  • Home visits
  • child care assistance
  • Meal preparation
  • Laundry and light cleaning
  • Grocery and prescription delivery
  • Short-distance travel for errands and appointments
  • And more

How can I get Papa Pals?

  1. You may receive a phone call from Papa Pals. They can sign you up during the phone call.
  2. You can call Papa Pals to sign up. Phone number: 1-888-345-2619; TTY users, please call 711. Business hours are 7 a.m. – 10 p.m. from Monday – Friday and 7 a.m. – 7 p.m. on Saturday and Sunday. (Tell them you are a member of Scott and White Health Plan.)

Pharmacy & Drugs

RightCare members can access prescriptions through any pharmacy that is contracted with Navitus Health Solutions. Navitus administers prescription benefits for RightCare STAR Members. For pharmacy questions, contact Customer Service at 1-855-897-4448.

You can view your pharmacy directory using the links below:

Formulary

RightCare uses the state mandated STAR formulary. The formulary is available on the Medicaid Drug Vendor Drug Program website.

The Texas STAR Formulary is available in paper form without charge. To request a copy, please call RightCare Customer Service at 1-855-897-4448.

Prior Authorizations

To obtain a prior authorization, providers should call Navitus at 1-877-908-6023. For a listing of clinical edits implemented by RightCare, click here. For access to RightCare'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 RightCare at 1-855-897-4448 for help with your medications and refills.

Member Forms

News

  • Manufacturer Reminder For Properly Submitting Rebate Invoices For additional information, click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information, click here.
  • 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, click here.
  • CGRP Antagonist Prophylaxis Prior Authorization Revisions Scheduled for Nov. 22, 2022 For additional information, click here.
  • Revision to Cosentyx Clinical Prior Authorization Criteria Scheduled for Nov. 22, 2022 For additional information, click here.
  • October 2022 NDC-to-HCPCS Crosswalk Now Available For additional information, click here.
  • Clinical Prior Authorization Criteria Revisions for Bylvay Scheduled for Nov. 21, 2022 For additional information, click here.
  • July 2022 Preferred Drug List Decisions Now Available For additional information, click here.
  • Clinical Criteria Update for Orkambi Scheduled for Nov. 9, 2022 For additional information, click here.
  • Summer 2022 RSV Season Schedule For additional information, click here.
  • 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, click here.
  • Revised VDP Manuals Available For additional information, click here.
  • Pharmacy Education Reminder For additional information, click here.
  • Agenda for October Drug Utilization Review Board Meeting Now Available For additional information, click here.
  • 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, click here.
  • Temporary Change in PDL Status for Clonidine Transdermal Patches Effective Sept. 26, 2022 For additional information, click here.
  • Clinical Prior Authorization Criteria Revisions Implement for Medicaid Fee-for-Service On Oct. 26, 2022 For additional information, click here.
  • September 2022 Specialty Drug List Available For additional information, click here.
  • Pharmacy Prior Authorization System Maintenance Scheduled for Monday, Oct. 3, 2022 For additional information, click here.
  • A Psychiatrist Sought for the Drug Utilization Review Board For additional information click here.
  • Bivalent Moderna COVID-19 Booster Vaccine Coverage Update For additional information click here.
  • Bivalent Pfizer COVID-19 Booster Vaccine Coverage Update For additional information, click here.
  • 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, click here.
  • 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, click here.
  • Drug Regimen Optimization Clinical Prior Authorization to Retire Sept. 12, 2022 For additional information click here.
  • Hepatitis C Treatment Coverage and PDL Update Scheduled for Sept. 1, 2022 For additional information, click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information, click here.
  • Clinical Prior Authorization for Xenical No Longer Required After Sept. 12, 2022 For additional information, click here.
  • 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 click here.
  • Revised VDP Manuals Available For additional information click here.
  • July 2022 Drug Utilization Review Board Meeting Summary For additional information click here.
  • EXTENDED: Members Sought for the Drug Utilization Review Board until Aug. 1, 2022 For additional information click here.
  • July 2022 NDC-to-HCPCS Crosswalk Now Available For additional information click here.
  • Novavax COVID-19 Vaccine Coverage Update For additional information click here.
  • Prior Authorization Criteria Update for Rinvoq and Cibinqo For additional information click here.
  • Semi-annual Medicaid Preferred Drug List Update Coming July 28, 2022 For additional information click here.
  • April 2022 Preferred Drug List Decisions Now Available For additional information click here.
  • Revised Application for Texas Identification Number Now Available for Pharmacy Enrollment For additional information click here.
  • HHSC Pharmacy Prior Authorization System Maintenance Scheduled for Early Morning This Wednesday For additional information click here.
  • HHSC to Reject Pharmacy Claims for Inaccurate License Information Beginning Sept. 28, 2022 For additional information click here.
  • Agenda for July Drug Utilization Review Board Meeting Now Available For additional information click here.
  • Revised VDP Manuals Available For additional information click here.
  • Clinical Prior Authorization Criteria Updates for Dupixent, Evrysdi, and Qelbree For additional information click here.
  • Pediatric Updates for Moderna & Pfizer-BioNTech COVID-19 Vaccines For additional information click here.
  • Medicare Part B and D Indicators Available on Formulary Searches Beginning June 6, 2022 For additional information click here.
  • EXTENDED: Members Sought for the Drug Utilization Review Board until July 1, 2022 For additional information click here.
  • COVID-19 Drug Veklury (Remdesivir) Update For additional information, click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information, click here.
  • Summer 2022 RSV Season Schedule For additional information, click here.
  • Pfizer COVID-19 Vaccine Booster Dose for Children Update For additional information, click here.
  • Moderna COVID-19 Vaccine Booster Dose Update For additional information, click here.
  • Respiratory Syncytial Virus (RSV) Prophylaxis Season Reopening Across All Regions For additional information, click here.
  • Changes for Client Access to Mosquito Repellent Benefit Begin June 1, 2022 For additional information, click here.
  • Spikevax COVID-19 Vaccine Coverage Update For additional information click here.
  • Members Sought for the Drug Utilization Review Board For additional information click here.
  • Changes for Client Access to Mosquito Repellent Benefit Begin June 1, 2022 For additional information click here.
  • Update to the Pharmacy Procedure Manual Now Available For additional information click here.
  • Second COVID-19 Vaccine Booster Dose Update For additional information click here.
  • Request for Pharmacies to Check That Pharmacy Licenses Are Current in PEMS For additional information click here.
  • April 2022 Drug Utilization Review Board Meeting Summary For additional information click here.
  • Revision to Makena Authorization Request Form Scheduled for June 10, 2022 For additional information click here.
  • January 2022 Preferred Drug List Decisions Now Available For additional information click here.
  • Update to the Pharmacy Procedure Manual Now Available For additional information click here.
  • March 2022 Specialty Drug List Available For additional information click here.
  • Agenda for April Drug Utilization Review Board Meeting Now Available For additional information click here.
  • Pharmacy Education Reminder For additional information click here.
  • Changes for Client Access to Mosquito Repellent Benefit Begin June 1, 2022 For additional information click here.
  • Draft Specialty Drug List Available for Comment For additional information click here.
  • Updates to Phosphate Binder Prior Authorization Criteria Scheduled for April 5, 2022 For additional information click here.
  • Cytokine and CAM Antagonists Criteria Updates Scheduled for April 5, 2022 For additional information click here.
  • Oxbryta Prior Authorization Criteria Updates Scheduled for April 5, 2022 For additional information click here.
  • January 2022 Drug Utilization Review Board Meeting Summary For additional information click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information click here.
  • 2021-22 Respiratory Syncytial Virus (RSV) Season Ends Feb. 1, 2022 For additional information click here.
  • January 2022 Preferred Drug List Now Available For additional information click here.
  • Temporary Change in PDL Status for Tetracyclines Drug Class, Effective Jan. 11, 2022 For additional information click here.
  • Pfizer-BioNTech COVID-19 Booster Update For additional information click here.
  • November 2021 Preferred Drug List Decisions Now Available For additional information click here.
  • Pfizer-BioNTech COVID-19 Vaccine Booster Dose Age Change and New Formulation For additional information click here.
  • Agenda for January Drug Utilization Review Board Meeting Now Available For additional information click here.
  • Managed Care Resources Update For additional information click here.
  • COVID-19 At-home Test Kits Available as a Pharmacy Benefit For additional information click here.
  • Pfizer Oral COVID-19 Drug, Paxlovid, Added to Formulary For additional information click here.
  • Medicaid Pharmacy Benefit Accredited Course, Quick Courses Available For additional information click here.
  • You Can Report Drug Shortages to HHSC For additional information click here.
  • Merck Oral COVID-19 drug, Molnupiravir, Added to Formulary For additional information click here.
  • Change in Age Limit for Pharmacist-Administered Influenza Vaccines For additional information click here.
  • Kidney Health Care Adds New Drugs to Formulary For additional information click here.
  • COVID-19 Vaccine Booster Update For additional information click here.
  • Semi-annual Medicaid Preferred Drug List Update Coming Jan. 27, 2022 For additional information click here.
  • Draft of Medication Therapy Management Policy Available for Comment For additional information click here.
  • Stimate Nasal Spray National Drug Shortage For additional information click here.
  • Pharmacy Services Change of Ownership (CHOW) Interim Process For additional information click here.
  • Promethazine Clinical Prior Authorization Criteria Updates Scheduled for Dec. 7, 2021 For additional information click here.
  • Dupixent Clinical Prior Authorization Criteria Update Scheduled for Jan. 4, 2022 For additional information click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information click here.
  • November 2021 Drug Utilization Review Board Meeting Summary For additional information click here.
  • July 2021 Preferred Drug List Revised Dec. 3, 2021 For additional information click here.
  • Removal of Specialist Requirement from Clinical Prior Authorization Criteria Scheduled for Jan. 3, 2022 For additional information click here.
  • Agenda for November Drug Utilization Review Board Meeting Now Available For additional information click here.
  • Order and Administration of Selected COVID-19 Monoclonal Antibody Therapeutics Reimbursable Through Medicaid Medical Claims System For additional information click here.
  • COVID-19 Vaccine Coverage Update: Comirnaty and Pfizer Age Change For additional information click here.
  • Removal of Specialist Requirement from Clinical Prior Authorization Criteria Scheduled for Jan. 3, 2021 For additional information click here.
  • Coverage of COVID-19 Booster Doses of Moderna and Johnson & Johnson Vaccines For additional information click here.
  • October 2021 NDC-to-HCPCS Crosswalk Now Available For additional information click here.
  • Updates to Medicaid Preferred Drug List Scheduled for Nov. 15, 2021 For additional information click here.
  • Pharmacy Submittal of COVID-19 Vaccine Additional, Booster Doses For additional information click here.
  • Nucala Clinical Prior Authorization Update Scheduled for Dec. 14, 2021 For additional information click here.
  • Repatha (evolocumab) Prior Authorization Update Scheduled for Dec. 6, 2021 For additional information click here.
  • Hepatitis C Drug Rebate Program Procurement Information Now Available For additional information click here.
  • HHSC Updates Respiratory Syncytial Virus (RSV) Season Schedule For additional information click here.
  • HHSC Issues Stromectol (Ivermectin) Guidance For additional information click here.
  • Temporary Change in Texas Pharmacy Prior Authorization Call Center Phone Number For additional information click here.
  • Alinia Clinical Prior Authorization Criteria Revision Effective Nov. 23, 2021 For additional information click here.
  • Updating Pharmacy Claim Systems for COVID-19 Vaccine Additional Doses For additional information click here.
  • 2021-22 RSV Assessment and Synagis Authorization For additional information click here.
  • Changes to Hepatitis C Prior Authorization Criteria Begin Sept. 1, 2021 For additional information click here.
  • Duplicate Therapy Clinical Prior Authorization Criteria Revision Begins Oct. 19, 2021 For additional information click here.
  • Respiratory Syncytial Virus and Synagis Authorization During Summer and Winter 2021-2022 For additional information click here.
  • July 2021 Drug Utilization Review Board Meeting Summary For additional information click here.
  • Atypical Respiratory Syncytial Virus (RSV) Season Advisory For additional information click here.
  • April 2021 Preferred Drug List Decisions Now Available For additional information click here.
  • July 2021 Preferred Drug List Now Available For additional information click here.
  • Changes to Hepatitis C Prior Authorization Criteria Begin Sept. 1, 2021 For additional information click here.
  • Trikafta Age Expansion in Cystic Fibrosis Agents Clinical Prior Authorization Begins Sept. 1, 2021 For additional information click here.
  • Nucala Clinical Prior Authorization Criteria Update Begins July 12, 2021 For additional information click here.
  • Semi-annual Medicaid Preferred Drug List Update Coming July 29, 2021 For additional information click here.
  • HHSC to Reopen RSV Season in Select Regions on June 21, 2021 For additional information click here.
  • Medicaid Allows Pfizer BioNTech COVID-19 Vaccine for Emergency Use in Adolescents For additional information click here.
  • HHSC to Resume Quarterly Specialty Drug List in July 2021 For additional information click here.
  • COVID-19 Testing in Pharmacy Reimbursable Through Medicaid Medical Claims System For additional information click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information click here.
  • April 2021 Preferred Drug List Recommendations Now Available For additional information click here.
  • COVID-19 Vaccine Administration Rate Change Effective April 1, 2021 For additional information click here.
  • January 2021 Preferred Drug List Decisions Now Available For additional information click here.
  • Enzymes Clinical Prior Authorization Criteria Revisions Effective June 30, 2021 For additional information click here.
  • Frequently Asked Questions about the Medicaid Standing Order for Mosquito Repellent For additional information click here.
  • Epidiolex Prior Authorization Revision Scheduled for May 11, 2021 For additional information click here.
  • Medicaid Adds Johnson & Johnson COVID-19 Vaccine to Formulary For additional information click here.
  • Revised Hepatitis C Drug Prior Authorization Form 1342 For additional information click here.
  • 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 click here.
  • 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 click here.
  • Preferred Drug List Criteria Exception for Macrolides Changes March 15 For additional information click here.
  • Renewed Texas Standing Order for Mosquito Repellent Benefit Available For additional information click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information click here.
  • January 2021 Preferred Drug List Now Available For additional information click here.
  • Desmopressin Clinical Prior Authorization Revision Begins March 15, 2021 For additional information click here.
  • COVID-19 Vaccine NDC Update For additional information click here.
  • Dupixent Clinical Prior Authorization Criteria Revision Effective March 15, 2021 For additional information click here.
  • Change to Thiazolidinediones Clinical Prior Authorization Begins Feb. 4, 2021 For additional information click here.
  • Medicaid Adds Moderna COVID-19 Vaccine to Formulary For additional information click here.
  • Medicaid Adds Pfizer BioNTech COVID-19 Vaccine to Formulary For additional information click here.
  • July 2020 Preferred Drug List Revised Dec. 16For additional information click here.
  • 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.
  • Semi-Annual Preferred Drug List Update Texas Medicaid is updating the Medicaid preferred drug list starting January 30. Visit the Vendor Drug Program website for the changes.
  • Morphine Equivalent Dose Limitations for RightCare to Decrease in January RightCare from Scott and White Health Plan will decrease the daily morphine equivalent dose limit for people enrolled in Medicaid Managed Care on Jan. 1, 2019. The new limit will be set at 90 and will apply to all opioid prescriptions, with exceptions for those people diagnosed with cancer or those receiving palliative or hospice care. Members can call 1-855-897-4448 for assistance.
  • Antipsychotics Clinic Prior Authorization Changes Begin Sept. 1 RightCare from Scott and White Health Plan will revise the antipsychotics clinical prior authorization for people enrolled in Managed Medicaid beginning 9/1/18. To learn more, please review the antipsychotics clinical prior authorization guide (PDF).
  • Notice of Change to Covered Services - Prescribed Pediatric Extended Care Center (PPECC)
  • The National Committee for Quality Assurance (NCQA) awarded Scott and White Health Plan an Accredited Status (Medicaid certified 03/2021) - reflecting our continuous work to fulfill NCQA requirements for consumer protection & quality improvement.