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
Texas Medicaid-CHIP Prior Authorization Criteria Guide
Non-Preferred drugs require a Preferred Drug List (PDL) Prior Authorization (PA) review. The Preferred Drug List and the PDL Criteria Guide can be found here.
Formulary drugs (Formulary drug search here) may require a Clinical Prior Authorization. Please see the Clinical PA criteria that Molina has implemented below.
