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:

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