Prior Authorization

The Texas Medicaid formulary includes some drugs subject to one or both types of prior authorization, clinical and non-preferred. Prior authorization must be approved before the drug is dispensed. Prior authorization is not a guarantee of payment. Even if a drug has been prior authorized, reimbursement can be affected for a variety of reasons (e.g., the client is ineligible on the date of service or the claim transaction is incomplete). The pharmacy should verify client eligibility status before submitting claims.

Some drugs are subject to one or both types of prior authorization, clinical and non-preferred.

Learn about the Texas Drug Utilization Review Board, the advisory group recommending changes to clinical prior authorization criteria and the preferred drug list.

Clinical Prior Authorizations

Non-preferred Prior Authorizations

Requesting Prior Authorization