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Two Semi-Annual Medicaid PDL Updates to Be Implemented in January 2026

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In January 2026, the Texas Health and Human Services Commission (HHSC) will implement two updates to the semi-annual Texas Medicaid Preferred Drug List (PDL) and the PDL Criteria Guide:

  • On January 1, 2026, HHSC will implement the recommendations that emerged from the October 2025 meeting of the Texas Drug Utilization Review (DUR) Board for the hepatitis C drug class.
    • The updated PDL Criteria Guide, which outlines the criteria that are used to evaluate the non-preferred prior authorization requests, will be published by November 21, 2025.
    • The updated the PDL will be published by December 29, 2025.
  • On January 30, 2026, HHSC will implement additional changes that are based on the July 2025 PDL decisions and the October 2025 PDL recommendations from the DUR Board. The updated PDL and PDL Criteria Guide will be published by January 26, 2025.

Preferred Drug Reminders

The following are reminders about preferred drugs:

  • Prescribing providers must use the Medicaid formulary and PDL. Providers who prescribe medications for clients who are enrolled in the Children's Health Insurance Program (CHIP) must use the CHIP formulary. CHIP does not have a preferred drug list.
  • The PDL does not include every drug on the Texas Medicaid formulary.
  • Drugs that are on the Texas Medicaid formulary are designated as preferred, non-preferred, or neither. The PDL includes only drugs that are identified as either preferred or non-preferred:
    • Drugs that are not on the preferred list and drugs that are identified as "preferred" are available without prior authorization.
    • Drugs that are on the preferred list and identified as "non-preferred" require prior authorization.
    • Some preferred and non-preferred drugs may require clinical prior authorization.
    • Some drugs on the formulary and the PDL are subject to one or both types of prior authorization, clinical and non-preferred.
    • Prescribing providers must obtain prior authorization for drugs that require it. Pharmacy staff may not request prior authorizations.

Obtaining Medicaid Outpatient Drug Prior Authorization

Prescribing providers must obtain prior authorization for outpatient drugs based on what Medicaid program a client is enrolled in.

  • For clients who are enrolled in a Medicaid managed care organization (MCO), prescribing providers or their representatives should contact the prior authorization call center that is specific to the client's MCO. Prior authorization call center phone numbers vary by MCO. Prescribers should use the MCO Search to find each MCO's prior authorization call center phone numbers.
  • For clients who are enrolled in traditional Medicaid, prescribing providers or their representatives should call the Texas Prior Authorization Call Center at 877-PA-TEXAS (877-728-3927) or submit the request online using the VDP Provider Portal.

Online Drug Reference Information

The following information is available online:

  • The Medicaid and CHIP formulary and Medicaid PDL are available on HHSC’s Vendor Drug Program website. Formulary information is also available for all state programs that are administered by HHSC.
  • A free subscription drug information tool called epocrates can be downloaded to a computer or handheld device. In addition to listing a drug’s preferred status, epocrates includes drug monographs, dosing information, and warnings. All prescribing providers are eligible to register for epocrates online. Refer to section 8.1 of the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook to learn more.
  • Prescribers may use their e-prescribing software to view the Medicaid and CHIP formularies or to find preferred drugs and alternatives to non-preferred medications.

72-Hour Emergency Supply

The prescribing provider is responsible for obtaining prior authorization. Pharmacy staff will alert the prescribing provider to get prior authorization if approval has not been obtained when the prescription is presented to the pharmacy. If medication is needed without delay, pharmacy staff can provide a 72-hour emergency supply of the medication while the prescribing provider obtains the authorization. Dispensing an emergency supply offers the person an immediate dose of the medicine, but they must return to the pharmacy to collect the entire prescription or receive alternative therapy.

Pharmacy Prior Authorization Quick Course

For a quick refresher on the Medicaid pharmacy benefit, including prior authorization, spend five minutes with the Prescriber's Guide to Medicaid Prior Authorizations.

Contact VDP

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