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.
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)
800-434-2347
888-760-2600 (STAR/CHIP)
855-315-5386 (Marketplace)
Navitus Health Solutions
1.877.908.6023
www.navitus.com
877-908-6023
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)
855-322-4080
888-672-2277
855-TX-RIGHT (855-897-4448)
1-877-908-6023
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