This applies to drugs that are non-preferred on the preferred drug list and/or because they are subject to clinical prior authorization. Pharmacies will be paid in full for 72-hour emergency prescription claims.
To learn what is required to submit a 72-hour emergency claims, pharmacy staff should refer to the Pharmacy Provider Procedure Manual. A 72-hour emergency prescription claim can be used for people enrolled in either Traditional Medicaid or Medicaid managed care:
- Authorization for Traditional Medicaid claims should be directed to the Texas Prior Authorization Call Center.
- Pharmacies submitting claims for people enrolled in Medicaid managed care should refer the prescribing provider to that person's health plan’s prior authorization call center.
We encourage pharmacy staff to post these instructions (PDF) in your pharmacy for reference and to reproduce this information for staff education.
December 13, 2018
July 2018 Preferred Drug List Revised Dec. 10
December 11, 2018
Morphine Dose Limitations for Traditional Medicaid to Decrease in Jan.
November 8, 2018
October 2018 Drug Utilization Review Board Meeting Summary
November 6, 2018
Clinical Prior Authorization Assistance Chart Now Available
October 31, 2018
2019 Drug Utilization Review Board Schedule Available
October 19, 2018
July 2018 Preferred Drug List Decisions Available