HHSC to Implement Enzymes Clinical Prior Authorization for Medicaid Fee-for-Service on April 18

March 28, 2023

On April 18, 2023, HHSC will implement the enzymes (PDF) clinical prior authorization for clients who are enrolled in Medicaid fee-for-service.

This clinical prior authorization is optional for Medicaid managed care organizations (MCOs).

The Pharmacy Clinical Prior Authorization Assistance Chart shows each MCO's prior authorizations and how these authorizations relate to those that are used for processing fee-for-service Medicaid claims. This chart is updated quarterly. Providers can refer to the MCO Resources page for links to each MCO’s list of clinical prior authorizations.