March 11, 2020

Texas Medicaid added new exception criteria to the Jan. 24 preferred drug list to check for a diagnosis of stage-four advanced metastatic cancer, or for treatment of symptoms associated with the cancer diagnosis. Prescribers must contact the pharmacy prior authorization call center and attest the person meets the exception criteria for the non-preferred drug to be approved because diagnoses are not readily available in a person’s medical claims data.

For Medicaid managed care

For traditional Medicaid

Non-preferred drugs may also require clinical prior authorization. Clinical prior authorizations may apply to an individual drug or an entire drug class, including some preferred and non-preferred drugs.