MedicaidPrior AuthMedium impact
Updated Pharmacy Clinical Prior Authorization Assistance Chart Now Available
Texas Medicaid·TX · Pharmacy·Prior Authorization
We identified it
Aug 14, 2026
Summary
Texas HHSC has released a quarterly update to the Pharmacy Clinical Prior Authorization Assistance Chart that maps prior authorization requirements across all Medicaid MCOs and the Vendor Drug Program (VDP). This chart helps billing teams understand which clinical prior authorizations each MCO requires for pharmacy claims, as requirements may vary between organizations.
Action Required
Immediately: Billing team must access the updated Pharmacy Clinical Prior Authorization Assistance Chart via the VDP website and cross-reference current MCO prior authorization requirements. Use the MCO search tool to identify each MCO's specific clinical prior authorization criteria, website, and call center contact information. Update internal prior authorization protocols and staff training materials to reflect any changes in MCO requirements. Ensure prior authorization workflows for pharmacy claims align with the most current chart. Contact vdp-formulary@hhs.texas.gov with any policy clarification questions. Failure to follow current MCO prior authorization requirements will result in claim denials.