Requests for pharmacy prior authorization may be submitted via fax or mail using the Texas Standard Prior Authorization Form.  Prescribing providers may continue, and are encouraged, to request prior authorization for traditional Medicaid patients by calling the Texas Prior Authorization Call Center. Please visit PAxpress for forms and addendums for clinical prior authorization requests. Prescribers must contact the managed care plan for the Texas Standard Prior Authorization Form and instructions for managed care Medicaid clients.

Internal Prior Authorization Forms

The following prior authorization forms are for people enrolled in traditional Medicaid.  All submissions must be from the prescribing physician..