Medicaid Non-preferred Prior Authorization

HHSC organizes the preferred drug list (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.

The PDL document is separated by therapeutic class, identifying the preferred agents, non-preferred agents, and any prior authorization criteria. The PDL identifies drugs requiring clinical prior authorization with a hyperlink to the clinical criteria document.

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

The Formulary search ( identifies drugs requiring non-preferred prior authorization. Users can click the " PDL PA Required" dropdown and select “yes” for all drugs requiring prior authorization or “no” for all drugs not requiring prior authorization.

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.

Refer to the Preferred Drug List Process to learn how HHSC includes drugs on the PDL. Refer to the Preferred Drug Documents for quarterly PDL recommendations and biannual PDL documents and criteria guide.