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Pharmacy Clinical Prior Authorization Assistance Chart Now Available

Last updated on 5/26/2023

The quarterly update to the Pharmacy Clinical Prior Authorization Assistance Chart is now available. The assistance chart identifies which prior authorizations are used by each managed care organization (MCO) and how these prior authorizations relate to those used by the Vendor Drug Program (VDP).

All 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.

VDP has published a criteria guide for each prior authorization that describes how Medicaid evaluates authorization requests. All steps from the guide apply to traditional Medicaid claims processed by the 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. VDP also provides a page with contact resources for MCOs, providers, and other stakeholders.

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