Clinical Prior Authorization for Xenical No Longer Required After September 12

August 9, 2022

Beginning September 12, 2022, HHSC will no longer require clinical prior authorization for Xenical (Orlistat) and will retire the following prior authorization requests:

  • Medicaid Xenical Clinic Prior Authorization (HHS Form 1331)
  • Medicaid Xenical Prior Authorization Addendum (HHS Form 1333) - used in conjunction with the Standard Prior Authorization Request (TDI Form NOFR002) 

HHSC will no longer require prior authorization for Xenical (Orlistat) because Medicaid covers the drug for the indication of obesity management and is not dependent on a hyperlipidemia condition.

The Xenical prior authorization is optional for managed care organizations.  Providers may reference the Pharmacy Clinical Prior Authorization Assistance Chart, which shows which prior authorizations each MCO has implemented.  This chart is updated quarterly.  Providers may also refer to the MCO Resources for links to each MCO's list of clinical prior authorizations.