Removal of Specialist Requirement from Clinical Prior Authorization Criteria Scheduled for January 3

Published on
November 5, 2021

On Jan. 3, HHSC will remove the specialist requirement from clinical prior authorization criteria listed below: 

The clinical prior authorization criteria impacted with this change are optional for managed care organizations.  The Pharmacy Clinical Prior Authorization Assistance Chart shows the prior authorization each MCO uses and how those authorizations relate to those used for processing fee-for-service Medicaid claims. This chart is updated quarterly. Providers can also refer to the MCO Resources for links to each MCO’s list of clinical prior authorizations.