Medicaid Pharmacy Prior Authorization
Review, download, and share this revised information about the Medicaid formulary, its preferred drug list, and which drugs require non-preferred and/or clinical prior authorization with our Medicaid Pharmacy Prior Authorization resource (PDF).

Medicaid Drug Formulary

The Vendor Drug Program Formulary is available to assist providers help their patients obtain medications.  Our formulary tools include information about which state programs cover each drug (e.g. Medicaid, CHIP) and whether a Medicaid non-preferred or clinical prior authorization is required.  Formulary information is available:

72-Hour Emergency Supply

It is the prescribing provider’s responsibility to obtain the prior authorization. In the event prior authorization has not been obtained at the time the prescription is presented at the pharmacy, pharmacies will alert the prescribing provider to obtain prior authorization.  Dispensing an emergency supply provides the client with an immediate dose of the medication but requires a return trip to the pharmacy for the full prescription or alternate therapy.  A 72-hour emergency prescription claim can be used for both Medicaid FFS service and managed care clients.

Free Continuing Education Credits

Texas Health Steps’ award-winning online program offers FREE CE Courses to enhance your ability to provide preventive health, mental health, oral health, and case management services to children who are Medicaid eligible in Texas.  Free CE courses are available from the Texas Health Steps website.

Criteria for Vitamin and Minerals Products for Medicaid

Vitamin and mineral products prescribed or ordered by a physician to treat various conditions are a benefit of Texas Medicaid through the Comprehensive Care Program (CCP) for clients who are 20 years of age and younger. The vitamin and mineral products included in this program are manually priced, when they are prior authorized (PA) and submitted to TMHP with the corresponding procedure code and state-identified modifier.  A portion of the CCP PA form must be completed by the prescribing provider.  See the Benefit Criteria for Vitamin and Mineral Products to Change for Texas Medicaid article in September/October 2011 edition of the TMHP Texas Medicaid Bulletin for additional information.