Most people enrolled in Medicaid and all people enrolled in the Children’s Health Insurance Program receive prescription drug benefits through the managed care delivery model.
- Contact the managed care organizations
- Managed care complaint process
- List of required and optional clinical prior authorizations
- Review the Clinical Prior Authorization Assistance Chart for prior authorizations used by each MCO
- MCO Resources
Drug Utilization Review Board
The Texas Drug Utilization Review Board meets quarterly in Austin to develop criteria and standards impacting the Texas Medicaid formulary. The board also develops recommendations for the Texas preferred drug list, suggests clinical prior authorizations for outpatient prescription drugs, recommends educational interventions for Medicaid providers, and reviews drug utilization across the Medicaid program.
- Agendas and Documents
- Drug Utilization Review Board Handbook
- Retrospective Drug Use Criteria Handbook
Resources for manufacturers with Texas Medicaid processes for formulary additions, billing, and federal and supplemental rebate programs.
A comprehensive list of documents and forms.
- Data Files
A collection of reports about the Medicaid outpatient pharmacy benefit.