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Electronic Prior Authorization Link

Providers are able to complete prior authorizations online via the following link:

Electronic Prior Authorization Information
Texas Standardized Prior Authorization Form for Prescription Drugs
Medicaid Prior Authorization Code Matrix for Outpatient Drug Services

Texas Medicaid-CHIP Prior Authorization Criteria Guide

Formulary drugs (Formulary drug search here) may require a Clinical Prior Authorization.

Please see the Clinical Prior Authorization Assistance Chart for Molina implemented Clinical Prior Authorization criteria.

Non-Preferred drugs require a Preferred Drug List (PDL) Prior Authorization (PA) review.

Temporary Non-Preferred drugs require a Temporary Non-Preferred (TNP) Prior Authorization Review.

The Preferred Drug List, PDL Criteria Guide, and Temporary Non-Preferred Drug Criteria can be found here.

Obtain additional guidance on how to submit a 72-hour emergency override here.

Caremark Provider Portal (For Maximum Allowable Costs Lists) click here.