Optional Managed Care Clinical Prior Authorization

Implementation of all other board-approved clinical prior authorization is optional and will vary between HHSC and the MCOs at the discretion of each MCO. An MCO may use any or all of the board-recommended clinical prior authorizations criteria but is not permitted to implement more stringent prior authorization criteria than the board approved.

Refer to the Managed Care Clinical Prior Authorization page (txvendordrug.com/formulary/clinical-prior-authorizations-managed-care) for the list of clinical prior authorizations MCOs have the option to perform for people enrolled in Medicaid.

Refer to the MCO Search for a link to the clinical prior authorization page on each MCO's website.