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Texas Medicaid Prior Authorization Form

Texas Medicaid Prior Authorization Form

Updated October 04, 2023

Texas Medicaid prior authorization form requests Medicaid coverage of a non-preferred drug in the State of Texas (a fillable PDF version of this form can be downloaded here). A non-preferred drug is a drug that does not appear on the State-approved Preferred Drug List. For more information, call one of the phone numbers provided below.

Texas Prior Authorization Call Center Phone Number – 1 (877) 728-3927

Texas Medicaid Phone Number – 1 (800) 925-9126

Preferred Drug List (PDL)