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Clinical Prior Authorization for Xenical No Longer Required After September 12, 2022

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Beginning September 12, 2022, the Texas Health and Human Services Commission (HHSC) will no longer require clinical prior authorization for Xenical (Orlistat) and will retire the following authorization forms:

  • Medicaid Xenical Clinic Prior Authorization (HHS Form 1331)
  • Medicaid Xenical Prior Authorization Addendum (HHS Form 1333), previously used in conjunction with the Standard Prior Authorization Request (TDI Form NOFR002) 

HHSC will no longer require prior authorization for Xenical (Orlistat) because Medicaid covers the drug for the indication of obesity management, and the drug is not dependent on a hyperlipidemia condition.

The Xenical prior authorization is optional for managed care organizations (MCOs). Providers may reference the Pharmacy Clinical Prior Authorization Assistance Chart, which shows the prior authorizations that each MCO has implemented. This chart is updated quarterly.

Providers may also refer to MCO Resources for links to each MCO’s list of clinical prior authorizations.

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