Texas Medicaid: State-required medication prior authorization and clinical criteria updates
AI Summary
UnitedHealthcare Community Plan of Texas is adding new prior authorization requirements and updating clinical criteria for certain medications across all Texas Medicaid programs (CHIP, STAR, STAR Kids, STAR+PLUS) effective October 15, 2025. This change is to comply with recent state requirements.
Action Required
By October 15, 2025: Billing and clinical staff must review the updated prior authorization requirements for medications under Texas Medicaid plans. Update workflow procedures to check prior authorization requirements before prescribing affected medications. Access detailed medication lists and clinical criteria through the UnitedHealthcare Provider Portal. Failure to obtain required prior authorizations may result in claim denials.
Plan Types
Medicaid
States
TX
Specialties
all-specialties