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Updated Clinical Prior Authorization Criteria Guides Now Available

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The Texas Health and Human Services Commission (HHSC) has reviewed and updated several clinical prior authorization criteria guides.

Managed care organizations (MCOs) will incorporate the clinical prior authorization updates to their list of clinical prior authorizations. 

The Pharmacy Clinical Prior Authorization Assistance Chart shows each MCO's prior authorizations and how they relate to prior authorizations that are used for processing fee-for-service Medicaid claims. This chart is updated quarterly. Providers can refer to the MCO search for links to each MCO’s list of clinical prior authorizations.

HHSC will notify pharmacies when any of these prior authorization criteria are implemented for Medicaid fee-for-service.

Email vdp-formulary@hhsc.state.tx.us with any comments or questions.