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Latest News

March 22, 2023

Implementation of Inhaled Antibiotics Clinical Prior Authorization for Medicaid Fee-For-Service Set for May 2

March 21, 2023

Revisions of Antimigraine Agents (Triptans) Clinical Prior Authorization Criteria Scheduled for April 4 (Revised)

March 1, 2023

Clinical Prior Authorization Criteria for Calcitonin Gene-Related Peptide Receptor Antagonists Effective April 4

February 22, 2023

Revision of Olumiant Clinical Prior Authorization Criteria Scheduled for March 27

February 15, 2023

Respiratory Syncytial Virus (RSV) Season Ends on March 1

What We Do

Manage the state Medicaid and CHIP formularies
Process out-patient pharmacy claims for people enrolled in traditional Medicaid, the Children with Special Health Care Needs Services Program, the Healthy Texas Women Program, and Kidney Health Care Program

I want to...

Enroll a pharmacy through the Provider Enrollment and Management System (PEMS)
Participate in managed care
Enroll a drug with Medicaid
Learn about the drugs and products available on the formularies
Search for outpatient drugs and products and clinician-administered drugs
Find a pharmacy or prescribing provider
Access my pharmacy's weekly payment
Review clinical prior authorizations or the preferred drug list
Submit a 72-hour emergency override claim
Reference the Pharmacy Provider Procedure Manual
Reference the Drug Manufacturer Manual
Attend the Texas Drug Utilization Review Board
Contact us