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Pharmacy Clinical Prior Authorization Assistance Chart Now Available

Last updated on 2/24/2023

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

All Medicaid managed care organizations (MCOs) must perform specific clinical prior authorizations. Clinical prior authorizations will vary among MCOs, and each MCO can decide which clinical prior authorization to use. The published criteria guide for each prior authorization describes how Medicaid evaluates authorization requests. The following pertains to the criteria guide:

  • 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 used by each MCO and how these prior authorizations relate to those used by VDP.

For more information about each MCO’s clinical prior authorization requirements, refer to the MCO Resources page. This page provides links to each MCO’s clinical prior authorizations and the call center phone number.

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