Both types of prior authorizations can be obtained by calling the appropriate call center. In most cases, authorizations are valid for one year.
Requests for prior authorization may be submitted only by the prescriber or a designated representative.
Individual drugs or classes of preferred drugs may require prior authorization based upon clinical criteria. Clinical prior authorization requirements vary among Medicaid health plans and should always be verified before a new prescription is submitted. For Medicaid FFS, call the Texas Prior Authorization Call Center at 877-728-3927 (877-PA TEXAS). Online requests are not accepted at this time. For Medicaid managed care, call the MCO's prior authorization call center to learn about processes and procedures. Download a chart with prior authorization call center information for Medicaid managed care health plans.
Non-preferred drugs require prior authorization. One exception involves patients who have a proven therapeutic failure with the preferred agent. In those cases, the non-preferred drug is considered pre-authorized and can be dispensed without approval from the call center. For Medicaid FFS or, call the Texas Prior Authorization Call Center at 877-728-3927 (877-PA TEXAS) or register with PAXpress to submit requests online. To register with PAXpress, select “PA Request” from the top navigation bar and create an account. For Medicaid managed care, call the MCO’s prior authorization call center to learn about processes and procedures. Download a chart with prior authorization call center information for Medicaid managed care health plans.
Enhanced search features are available through the formulary search function and RXpert® . Both sites allow you to search the formulary, view clinical prior authorizations and criteria, and find applicable alternate therapies.
The formulary and PDL are also available in the Epocrates system. Registration to Epocrates is free.
Some drugs are subject to both non-preferred and clinical prior authorization. If a prescription is submitted without required prior authorization, the pharmacy will notify the prescriber before dispensing the medication.
By using the VDP formulary and PDL and obtaining prior authorization for prescriptions when necessary, you will help ensure that patients covered by Medicaid and other programs receive their medications without delay.