Updated Texas Clinical Prior Authorization Criteria Guides Released

The Texas Health and Human Services Commission (HHSC) has completed a review and update of several clinical prior authorization criteria guides.

Managed care organizations (MCOs) are responsible for incorporating these updates into their respective lists of clinical prior authorizations.

The Pharmacy Clinical Prior Authorization Assistance Chart provides a comparison of each MCO’s prior authorizations with those used to process fee-for-service Medicaid claims. This chart is updated on a quarterly basis.

Providers may use the MCO search tool to access links to each MCO’s list of clinical prior authorizations.

HHSC will issue notifications to pharmacies whenever updated prior authorization criteria are implemented for Medicaid fee-for-service.

Comments or questions may be directed to vdp-formulary@hhsc.state.tx.us.