HHSC arranges the PDL by drug class, and it contains a subset of many, but not all, drugs found on the Medicaid formulary. Preferred drugs on the PDL are selected using criteria based on safety, efficacy and cost, and are available without prior authorization unless there is a clinical prior authorization associated with the drug. Non-preferred drugs require a PDL prior authorization. Some preferred drugs may also require clinical prior authorization.

The PDL Criteria Guide explains the criteria used to evaluate the non-preferred prior authorization requests.

MCOs use the same non-preferred prior authorization criteria requirements but may have non-preferred requirements on a limited set of home health supplies provided by Medicaid-enrolled pharmacies.