Pharmacy prior authorization services for people enrolled in Medicaid managed care are administered by the person's managed care organization (MCO). Please refer to the Prescriber 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 clinincal prior authorization. Traditional Medicaid (fee for service) 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 clinincal prior authorization requests.
The Provider Quick Reference (PDF) outlines the information that 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 then 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. The emergency override claim can be used for both fee-for-service and managed care members. 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 authorizationss 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.
March 6, 2018
Members Sought for Drug Utilization Review Board
February 14, 2018
Quarterly Clinical Prior Authorization Assistance Chart Available
February 14, 2018
Texas Medicaid Preferred Drug List Updates March 9
February 9, 2018
November 3, 2017 Preferred Drug List Decisions
February 1, 2018
February 2018 Preferred Drug List
January 23, 2018
January 2018 Texas Medicaid Preferred Drug List Update