A Prescriber’s Guide to Texas Medicaid Outpatient Pharmacy Prior Authorization

A Prescriber’s Guide to Texas Medicaid Outpatient Pharmacy Prior Authorization

pharmacist filling prescription

What you'll learn

When and how to obtain prior authorization for outpatient prescriptions for patients enrolled in Texas Medicaid fee-for-service or managed care.

Texas Medicaid Outpatient Pharmacy Benefits

The Texas Health and Human Services Commission (HHSC) Vendor Drug Program (VDP) oversees the outpatient pharmacy program for children and adults enrolled in:

  • Fee-for-service (FFS) Medicaid, including Texas Health Steps
  • Medicaid managed care, including STAR, STAR+PLUS, STAR Health and STAR Kids
  • Children’s Health Insurance Program (CHIP)
  • Children with Special Health Care Needs program
  • Healthy Texas Women program
  • Kidney Health Care program

In this quick course you will learn the basics of using the VDP formulary and Preferred Drug List, determining whether prior authorization is required before a prescription can be dispensed and completing the prior authorization process. Your knowledge will help ensure that patients can receive their medications without delay or complication.