Pharmacy prior authorization services for people enrolled in Medicaid managed care are administered by the person's managed care organization. Refer to the Prescriber MCO Assistance Chart (PDF) for prior authorization call center phone numbers for each MCO.
Only the prescribing provider or a staff representative can request non-preferred or clinical prior authorization. Traditional Medicaid prior authorizations are administered by the Texas Prior Authorization Call Center. HHSC contracts with Health Information Designs, LLC. for call center and enhanced formulary services.
- 1-877-PA-TEXAS (1-877-728-3927) - (Monday-Friday, 7:30 a.m. to 6:30 p.m. central time)
- For non-preferred or clinical prior authorization requests.
The Provider Quick Reference (PDF) outlines the information call center staff requires to quickly assist each caller. Requests with missing information will not be assessed until that information is provided. If the authorization request is approved then the person can return to their pharmacy to obtain the prescription. The claim will pay and no further action will be required. If the authorization request is denied the prescribing physician's office will be notified. In addition:
- A 72-hour emergency supply of a prescribed drug must be provided when a medication is needed without delay and authorization is not available. An emergency override claim is available to all people enrolled in Medicaid. Pharmacy staff are encouraged to post these instructions in your pharmacy for reference and to reproduce this information for staff education.
- The prescriber has the option of prescribing a different treatment course that does not require prior authorization or submitting the Texas Medicaid Prior Authorization Reconsideration Request (HHS Form 1322). Determination of the reconsideration will be mailed to the requesting prescriber and the patient.
- The enhanced formulary at PAXpress identifies Medicaid formulary drugs, clinical prior authorizations for specific drugs, and alternate therapies that are allowed, where applicable.
- If PAXpress is unavailable please contact the Texas Prior Authorization Technical Helpdesk at 1-334-321-0177.
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