Clinical Prior Authorization File Layout
Last Updated
This layout document contains all drugs on the Medicaid formulary with clinical prior authorization criteria requirements for traditional Medicaid. HHSC updates the database weekly. Data from the file appears on the formulary drug search.
| Field Name | Description | Length | Format | Note |
|---|---|---|---|---|
| Drug_NDC | Identifies the 11-digit National Drug Code (NDC) number | 11 | ||
| Drug_cpa_description | Identifies the clinical prior authorization criteria name | 100 | ||
| Drug_cpa_url | Identifies the hyperlink to the clinical prior authorization criteria document | 150 | ||
| Drug_cpa_EffDate | Identifies the clinical prior authorization criteria effective date | 10 | MM/DD/CCYY | |
| Drug_cpa_EndDate | Identifies the clinical prior authorization criteria termination date | 10 | MM/DD/CCYY |