June 4, 2018

The Vendor Drug Program will revise the anti-psychotics clinical prior authorization for people enrolled in traditional Medicaid beginning July 2. The revision will allow for an initial 90-day grace period for newly-diagnosed patients until his or her diagnosis appears in the pharmacy prior authorization system. To learn more please review the anti-psychotics clinical prior authorization criteria guide (PDF).

This prior authorization is optional for people enrolled in Medicaid managed care. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization each health plan uses and how those authorizations relate to the authorizations used for traditional Medicaid claim processing.  This chart is updated quarterly. Providers can also refer to our MCO Resources for links to each health plan's clinical prior authorizations.