Prescribers

Pharmacy providers must enroll with Texas Medicaid before participating in any managed care pharmacy network. Some Medicaid drugs are subject to one or both types of prior authorization:  clinical and non-preferred. There are certain clinical prior authorizations that all Medicaid managed care organizations are required to perform. Usage of all other clinical prior authorizations will vary at the discretion of each MCO.

You can view the Drug Formulary and Preferred Drugs or see Epocrates.com for detailed information.

Providers are encouraged to utilize e-prescribing through surescripts.com, including for controlled substances.

The Prescriber MCO Assistance Chart(PDF) identifies each MCO's prior authorization and member call center. The MCO must notify the prescribing provider of authorization approval or denial within 24 hours of the time of the request.

MCO
Contact

800-306-8612 (Tarrant service area)
800-248-7767 (Bexar service area)
866-510-3710 (Fax)

800-601-4829 (Retail Prior Authorization)
800-359-5781 (Medical Injectables)
Provider Services: 1-800-454-3730

855-457-0405 (STAR)
855-457-0403 (CHIP)
855-457-0757 (STAR Kids) (Travis service area)
855-457-0758 (STAR Kids) (MRSA Central service area)
877-243-6930 (Pharmacy Prior Auth Fax)

1-800-947-4969                              
Navitus Pharmacy Help Desk: 1-877-908-6023
Navitus Fax: 1-855-668-8553

877-428-3057 (Medicaid)
800-359-5613 (CHIP)
469-282-3012 (Fax)

888-760-2600 (STAR/CHIP)
855-315-5386 (Marketplace)
Navitus  Health Solutions
1.877.908.6023
www.navitus.com

877-908-6023 (STAR/CHIP)
800-592-5108 (Commercial Cigna)
Phone: 1-877-908-6023 (Navitus)

77-324-3627 (Nueces service area)
855-425-3247 (Hidalgo service area)

855-TX-RIGHT (855-897-4448)
1-877-908-6023

1-877-398-9461,  ext. 22168 (Appeal Requests)
1-800-218-7508 (Inpatient Rx Administration Prior Authorization  Requests)
1-800-460-8988 (Out-Patient Rx [Envolve Pharmacy Solutions] Resolution Help  Desk Phone)
1-866-768-7147 (Prior Authorization Requests)

877-908-6023
855-668-8553 (Fax)

800-310-6826
866-940-7328 (Fax)

A pharmacy may give a 72-hour authorization override in the event that an authorization is not received in time for a prescription needed by a member immediately. View details