Updated Pharmacy Clinical Prior Authorization Assistance Chart Now Available

Date: June 24, 2025

Attention: All Providers

Call to action: The purpose of this communication is to inform providers the quarterly update to the Pharmacy Clinical Prior Authorization Assistance Chart is now available. This chart shows which prior authorizations each managed care organization (MCO) uses and how these prior authorizations relate to those that the Vendor Drug Program (VDP) uses.

All Medicaid MCOs must perform specific clinical prior authorizations. These authorizations may differ between MCOs, and each MCO chooses which ones to use. The published criteria guide explains the steps that Medicaid follows to review authorization requests. These steps also apply to traditional Medicaid claims that are processed by the VDP.

Next step for providers: For more information about each MCO’s clinical prior authorization requirements, use the MCO search tool, and follow the search instructions on the VDP website. The search results include each MCO’s clinical prior authorization website and call center phone number.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts,log into:
www.texaschildrenshealthplan.org/provideralerts.