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Pharmacy Clinical Prior Authorization Assistance Chart Now Available

Last updated on 11/20/2020

The quarterly update to the Pharmacy Clinical Prior Authorization Assistance Chart is now available. 

All Medicaid managed care organizations (MCOs) must perform certain clinical prior authorizations. Other clinical prior authorizations will vary among MCOs; usage is at the discretion of each MCO. The published criteria guide for each prior authorization describes how authorization requests are evaluated:

  • All steps from the criteria guide apply to traditional Medicaid claims processed by the Vendor Drug Program (VDP).
  • This assistance chart identifies which prior authorizations are utilized by each MCO, and how those prior authorizations relate to those used by VDP.

For more information about each MCO’s clinical prior authorization requirements, providers can refer to the following resources:

Contact vdp-operations@hhsc.state.tx.us with comments or any questions.