Preferred drugs are medications recommended by the Texas Drug Utilization Review (DUR) Board for their efficaciousness, clinical significance, cost effectiveness, and safety for clients. The Preferred Drug List (PDL) is published every January and July.
The tentative 2016 class review schedule and upcoming product review information is available from Provider Synergies.
MCO Clinical Prior Authorization Comparison Chart Available
Each MCO has the option to develop their own algorithms for clinical prior authorization as long as it is no more stringent than the board-approved criteria. This Pharmacy Clinical Prior Authorization Assistance Chart (PDF) identifies which criteria are utilized by each MCO and how those criteria relate to those used by VDP.
About Preferred Drugs
All currently approved products on the Texas Medicaid Formulary are available to all Medicaid clients.
Preferred products are available without authorization. Authorization for non-preferred products requires the prescribing provider or provider representative calling the appropriate authorization authority:
- Contact the Texas Prior Authorization Call Center for Medicaid fee-for-service clients.
- Prior authorization call centers vary by managed care health plan. The Prescriber Assistance Chart (PDF) identifies prior authorization and member call center phone numbers for each plan.
Approved requests for authorization are valid for one year.
Certain groups of clients based on age or other criteria may be exempt from PDL requirements.
We encourage all pharmacy staff to review the 72-hour emergency prescription override instructions (PDF), to post in your pharmacy for easy reference, and to reproduce this information for educational purposes with your staff. The 72-hour override applies to clients enrolled in either fee-for-service or Medicaid managed care.
The PDL is also available through Epocrates.
Preferred Drug List
- Preferred Drug List and Prior Authorization Criteria (01/2017) (PDF)
- Published January 26, 2017.
- Preferred Drug List and Prior Authorization Criteria (07/2016) (PDF)
- Published July 21, 2016. Revised August 12, 2016.
- Preferred Drug List and Prior Authorization Criteria (01/2016) (PDF)
- Published January 28, 2016. Revised May 20, 2016.
- Preferred Drug List and Prior Authorization Criteria (07/2015) (PDF)
- Published July 23, 2015. Revised October 6, 2015.
- Preferred Drug List and Prior Authorization Criteria (01/2015) (PDF)
- Published January 22, 2015. Revised April 30, 2015.