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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 some clinical prior authorization criteria guides.

Managed care organizations (MCOs) will incorporate the clinical prior authorization updates into their lists 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.

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

Email vdp-formulary@hhs.texas.gov with comments or any questions.