The quarterly update to the Pharmacy Clinical Prior Authorization Assistance Chart is now available. This 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 Medicaid 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. All steps from the criteria guide apply to traditional Medicaid claims that are processed by the VDP.
For more information about each MCO’s clinical prior authorization requirements, refer to the MCO Search on the VDP website. The search results identify the clinical prior authorization website and clinical prior authorization call center phone number for each MCO.
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