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Provider Directories

Extra Member Benefits

RightCare offers benefits and services in addition to basic Medicaid covered services for our members. For assistance with getting a reward card, RightCare Members can visit myplanperksrightcare.novu.com.

Help for Members with Asthma

  • Regular Refills $50 Gift Card
  • $20 Gift Card for Asthma Disease Management participation

Extra Help for Pregnant Women

  • $75 Gift Card for a Prenatal Visit
  • $75 Gift Card for a Postpartum Visit
  • $20 Gift Card for Going to a Baby Shower and Prenatal Visit
  • $20 Gift Card for Going to a Baby Shower and Postpartum Visit

Extra Benefits for Children

  • $50 Gift Card for 6 Texas Health Steps Checkups by 15 months
  • $50 Toward a Toddler Car Seat
  • $20 Toward a Booster Car Seat
  • $25 Gift Card for a Timely Texas Health Steps Checkup

Additional Behavioral Health Benefits

  • $20 Gift Card for a Behavioral Health Inpatient Follow-up Visit

Extra Help Getting a Ride

  • One monthly ride for members to go to the grocery store, WIC appointments, health education classes, fitness centers, vocational trainings, job interviews, self-help group meetings, places of worship/religious services, pregnancy/birthing classes, newborn classes, CPR/first aid classes, RightCare Member Advisory Groups, or RightCare Baby Showers. To set up a ride, Call RightCare Nonemergency Medical Transportation at 1-877-447-3101 or fill out our form. Rides must be requested 3 days before your scheduled trip. You can also download the A2C app, Access2Care’s no cost mobile app. You can find it in both Apple App and Google Play stores.

Member Forms

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Member Notices

  • Change in Preferred Drug List Status for the Smoking Cessation Drug Class Effective May 16, 2023 For additional information, click here.
  • HHSC to Implement Clinical Prior Authorization for Gattex on June 6, 2023 For additional information, click here.
  • HHSC to Implement Clinical Prior Authorization for Antimigraine Agents-Ergot Derivatives on June 6, 2023 For additional information, click here.
  • Members Sought for the Drug Utilization Review Board For additional information, click here.
  • HHSC to Revise Qulipta Criteria for Clinical Prior Authorization on June 27, 2023 For additional information, click here.
  • HHSC to Implement Sotyktu Criteria in Cytokine and CAM Antagonists Clinical Prior Authorization on July 27, 2023 For additional information, click here.
  • HHSC to Implement Pulmonary Hypertension Agents Clinical Prior Authorization on July 27, 2023 For additional information, click here.
  • Preferred Mavyret for Hepatitis C Infection Treatment and Change to Quantity Limit for Hepatitis C Medications
  • 05/11/2023 Background:

    HHSC published the notice “Preferred Mavyret for Hepatitis C Infection Treatment and Change to Quantity Limit for Hepatitis C Medications” on May 1, 2023.

    Key Details:

    This update is to clarify the following notice regarding the quantity limit change for Hepatitis C infection treatment. The quantity limit change in this notice applies to all Hepatitis C DAA medications, not just the NDCs listed in the table below.

    Quantity Limit Change

    HHSC intends this initiative to increase awareness, screening, diagnosis, and treatment for Medicaid clients. HHSC will help improve access and adherence by allowing prescribers to write prescriptions for the entire course of therapy so clients will no longer need to request additional refills throughout their treatment duration. Prescribers may choose to write a prescription for the entire treatment cycle or have the client return for further testing if warranted. This change applies to all Hepatitis C DAA medications.

    By May 25, 2023, MCOs must update pharmacy quantity supply limits and maximum day supply coverage on DAA medications to allow access to the entire course of therapy. Prescribers may identify some clients needing to take the medication longer than others. MCOs may allow longer treatment duration upon prescriber request. MCOs must inform their providers and members of this change.

    Reminder

    All Medicaid clients are eligible for DAA treatment with the primary preferred agent regardless of the client’s METAVIR fibrosis score, and prior authorization is not required. Any enrolled Medicaid provider can prescribe the preferred drug, and HHSC does not require a drug screening. The table below summarizes the national drug codes (NDCs) impacted by the PDL change:

    Drug Name NDC Jan 1, 2023 PDL status
    Mavyret 00074260028
    00074262528
    Preferred
    Epclusa 61958220101
    61958220301
    61958220401
    61958220402
    61958220501
    61958220502
    Non-Preferred
    Vosevi 61958240101 Non-Preferred

    HHSC published an update to the Texas Medicaid Preferred Drug List (PDL) on Jan. 1, 2023, designating the preferred and non-preferred options for DAA treatment. HHSC also included the changes in the daily PDL file delivered to managed care plans via TXMedConnect. PDL statuses were future-dated to reflect the Jan. 1 changes.

    HHSC did not change the PDL status for all other non-preferred DAA drugs currently on the formulary. For any non-preferred DAA drugs, HHSC will continue to apply PDL prior authorization criteria for all Medicaid clients, both fee-for-service and managed care.

    HHSC asks MCOs to continue to remind their providers and members regarding the availability of Hepatitis C treatment coverage.

    Contact: vdp-operations@hhsc.state.tx.us

  • HHSC Removed Monovalent Moderna and Pfizer-BioNTech COVID-19 Vaccines From Formulary on April 21, 2023 For additional information, click here.
  • HHSC to Update Hereditary Angioedema Clinical Prior Authorization For Fee-For-Service on May 23, 2023 For additional information, click here..
  • HHSC to Update Anxiolytics and Sedative-Hypnotics Clinical Prior Authorization For Fee-For-Service on June 22, 2023 For additional information, click here.
  • Jan. 2023 Preferred Drug List Decisions Now Available For additional information, click here.
  • Update to "HHSC To Implement Clinical Prior Authorizations For Fee-For-Service" For additional information, click here.
  • Pharmacy Email Addresses Must Be Current in PEMS For additional information, click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information, click here.
  • Memorial Day Holiday to Delay Pharmacy Payments For additional information, click here.
  • HHSC to Revise Opiate/Benzodiazepine/Muscle Relaxant Combinations Prior Authorization For additional information, click here.
  • Summary of April 2023 Drug Utilization Review Board Meeting Now Available For additional information, click here.
  • HHSC To Update Opioid Product Information in Clinical Prior Authorizations for Medicaid Fee-for-Service For additional information, click here.
  • April 2023 NDC-to-HCPCS Crosswalk Now Available For additional information, click here.
  • Revised VDP Manuals Available For additional information, click here.
  • CSHCN Removes Remodulin From Formulary As Of April 17, 2023 For additional information, click here.
  • CSHCN To Remove Multiple Drugs From Formulary on June 1, 2023 For additional information, click here.
  • Age Expansion Indication for Cibinqo Clinical Prior Authorization Criteria Effective May 31, 2023 For additional information, click here.
  • Update to Livmarli Clinical Prior Authorization Criteria Effective May 30, 2023 For additional information, click here.
  • Makena Products No Longer Covered As Of April 7, 2023 For additional information, click here.
  • Agenda for April Drug Utilization Review Board Meeting Now Available For additional information, click here.
  • Texas State Plan Public Notice of Intent for Waiver of Drug Counseling Signature Requirements For additional information, click here.
  • March 2023 Specialty Drug List Available For additional information, click here.
  • Hereditary Angioedema Agents Clinical Prior Authorization Effective for Medicaid Fee-for-Service on April 11, 2023 For additional information, click here.
  • HHSC to Implement Enzymes Clinical Prior Authorization for Medicaid Fee-for-Service on April 18, 2023 For additional information, click here.
  • Temporary Change in PDL Status for the Neuropathic Pain Drug Class Effective April 3, 2023For additional information, click here.
  • Pharmacy Education Information and OpportunitiesFor additional information, click here.
  • Revisions of Antimigraine Agents (Triptans) Clinical Prior Authorization Criteria Scheduled for April 5, 2023 (Revised) For additional information, click here.
  • Implementation of Inhaled Antibiotics Clinical Prior Authorization for Medicaid Fee-For-Service Set for May 2, 2023For additional information, click here.
  • HHSC To Implement Multiple Clinical Prior Authorizations For Fee-For-Service For additional information, click here.
  • Pharmacy Resolution Help Desk Down Due To Statewide Outages For additional information, click here.
  • Extended Database Maintenance For Pharmacy Claims Vendor Weekend of March 18, 2023 For additional information, click here.
  • Draft Specialty Drug List Available for Comment, Responses Due March 17, 2023 For additional information, click here.
  • Clinical Prior Authorization Criteria for Calcitonin Gene-Related Peptide Receptor Antagonists Effective April 4, 2023 For additional information, click here.
  • Revised VDP Manuals Available For additional information, click here.
  • 2022-23 RSV Season Schedule For additional information, click here.
  • Respiratory Syncytial Virus (RSV) Season Ends on March 1, 2023 For additional information, click here.
  • Revisions of Antimigraine Agents (Triptans) Clinical Prior Authorization Criteria Scheduled for April 4, 2023 For additional information, click here.
  • Revision of Olumiant Clinical Prior Authorization Criteria Scheduled for March 27, 2023 For additional information, click here.
  • January 2023 Drug Utilization Review Board Meeting Summary For additional information, click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information, click here.
  • January 2023 Preferred Drug List Updated For additional information, click here.
  • Changes to Lovaza Clinical Prior Authorization Scheduled for March 21, 2023 For additional information, click here.
  • January 2023 NDC-to-HCPCS Crosswalk Now Available For additional information, click here.
  • Changes in Hepatitis C Treatment Coverage for Medicaid Clients Begins Jan. 1, 2023 For additional information, click here.
  • Clinical Prior Authorization Criteria Changes Scheduled for Feb. 7, 2023 For additional information, click here.
  • Androgenic Agents Clinical Prior Authorization Criteria Revision Scheduled for Feb. 1, 2023 For additional information, click here.
  • Younger Age Groups Now Eligible For Updated Bivalent COVID-19 Vaccines For additional information, click here.
  • July 2022 Preferred Drug List Updated For additional information, click here.
  • Pharmacy Education Information and Opportunities For additional information, click here.
  • NDC Requirements for the Submission of Clinician-Administered Drug Claims For additional information, click here.
  • Revised VDP Manuals Available For additional information, click here.
  • Agenda for January Drug Utilization Review Board Meeting Now Available For additional information, click here.
  • Retroactive Claim Form Process Ending Dec. 31, 2022 For additional information, click here.
  • Revised VDP Manuals Available For additional information, click here.
  • Clinical Prior Authorization for Calcitonin Gene-Related Peptide Receptor (CGRP) Antagonists in Traditional Medicaid Begins Dec. 30, 2022 For additional information, click here.
  • Genabio COVID-19 At-Home Test Kit Added to Formulary For additional information, click here.
  • Semi-annual Medicaid Preferred Drug List Update Coming Jan. 26, 2023 For additional information, click here.
  • Hepatitis C Treatment Coverage and PDL Update Scheduled for Jan. 1, 2023 For additional information, click here.
  • Manufacturer Reminder For Properly Submitting Rebate Invoices For additional information, click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information, click here.
  • Input on Proposed Medicaid, CHIP Formulary, PDL and Prior Authorization Management Transition Policy Due Dec. 4, 2022 For additional information, click here.
  • Revised VDP Manuals Available For additional information, click here.
  • October 2022 Drug Utilization Review Board Meeting Summary For additional information, click here.
  • New Report from HHSC For additional information, click here.
  • CGRP Antagonist Prophylaxis Prior Authorization Revisions Scheduled for Nov. 22, 2022 For additional information, click here.
  • Revision to Cosentyx Clinical Prior Authorization Criteria Scheduled for Nov. 22, 2022 For additional information, click here.
  • October 2022 NDC-to-HCPCS Crosswalk Now Available For additional information, click here.
  • Clinical Prior Authorization Criteria Revisions for Bylvay Scheduled for Nov. 21, 2022 For additional information, click here.
  • July 2022 Preferred Drug List Decisions Now Available For additional information, click here.
  • Clinical Criteria Update for Orkambi Scheduled for Nov. 9, 2022 For additional information, click here.
  • Summer 2022 RSV Season Schedule For additional information, click here.
  • RSV Fall/Winter Traditional Season Regional Changes Effective Oct. 17, 2022 For additional information, click here.
  • 2022-23 RSV Season Schedule For additional information, click here.
  • ProAir HFA Inhaler Discontinuation For additional information, click here.
  • Revised VDP Manuals Available For additional information, click here.
  • Pharmacy Education Reminder For additional information, click here.
  • Agenda for October Drug Utilization Review Board Meeting Now Available For additional information, click here.
  • PDL Prior Authorization Criteria Revisions Scheduled For Oct. 11, 2022 For additional information, click here.
  • Criteria Changes for Subsequent Dosing of Palivizumab (Synagis) with Fall/Winter Traditional Respiratory Syncytial Virus Season For additional information, click here.
  • Temporary Change in PDL Status for Clonidine Transdermal Patches Effective Sept. 26, 2022 For additional information, click here.
  • Clinical Prior Authorization Criteria Revisions Implement for Medicaid Fee-for-Service On Oct. 26, 2022 For additional information, click here.
  • September 2022 Specialty Drug List Available For additional information, click here.
  • Pharmacy Prior Authorization System Maintenance Scheduled for Monday, Oct. 3, 2022 For additional information, click here.
  • A Psychiatrist Sought for the Drug Utilization Review Board For additional information click here.
  • Bivalent Moderna COVID-19 Booster Vaccine Coverage Update For additional information click here.
  • Bivalent Pfizer COVID-19 Booster Vaccine Coverage Update For additional information, click here.
  • Hepatitis C Treatment Coverage and PDL Update Scheduled for Jan. 1, 2023 For additional information, click here.
  • RSV Summer Season Changes Begin Sept. 1, 2022 For additional information, click here.
  • Draft Specialty Drug List Available for Comment, Responses Due Sept. 22, 2022 For additional information, click here.
  • July 2022 Preferred Drug List Updated For additional information, click here.
  • Drug Regimen Optimization Clinical Prior Authorization to Retire Sept. 12, 2022 For additional information click here.
  • Hepatitis C Treatment Coverage and PDL Update Scheduled for Sept. 1, 2022 For additional information, click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information, click here.
  • Clinical Prior Authorization for Xenical No Longer Required After Sept. 12, 2022 For additional information, click here.
  • Hepatitis C Treatment Coverage and PDL Update Scheduled for Sept. 1, 2022 For additional information, click here.
  • July 2022 Preferred Drug List Now Available For additional information click here.
  • Revised VDP Manuals Available For additional information click here.
  • July 2022 Drug Utilization Review Board Meeting Summary For additional information click here.
  • EXTENDED: Members Sought for the Drug Utilization Review Board until Aug. 1, 2022 For additional information click here.
  • July 2022 NDC-to-HCPCS Crosswalk Now Available For additional information click here.
  • Novavax COVID-19 Vaccine Coverage Update For additional information click here.
  • Prior Authorization Criteria Update for Rinvoq and Cibinqo For additional information click here.
  • Semi-annual Medicaid Preferred Drug List Update Coming July 28, 2022 For additional information click here.
  • April 2022 Preferred Drug List Decisions Now Available For additional information click here.
  • Revised Application for Texas Identification Number Now Available for Pharmacy Enrollment For additional information click here.
  • HHSC Pharmacy Prior Authorization System Maintenance Scheduled for Early Morning This Wednesday For additional information click here.
  • HHSC to Reject Pharmacy Claims for Inaccurate License Information Beginning September 28, 2022 For additional information click here.
  • Agenda for July Drug Utilization Review Board Meeting Now Available For additional information click here.
  • Revised VDP Manuals Available For additional information click here.
  • Clinical Prior Authorization Criteria Updates for Dupixent, Evrysdi, and Qelbree For additional information click here.
  • Pediatric Updates for Moderna & Pfizer-BioNTech COVID-19 Vaccines For additional information click here.
  • Medicare Part B and D Indicators Available on Formulary Searches Beginning June 6, 2022 For additional information click here.
  • EXTENDED: Members Sought for the Drug Utilization Review Board until July 1, 2022 For additional information click here.
  • COVID-19 Drug Veklury (Remdesivir) Update For additional information, click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information, click here.
  • Summer 2022 RSV Season Schedule For additional information, click here.
  • Pfizer COVID-19 Vaccine Booster Dose for Children Update For additional information, click here.
  • Moderna COVID-19 Vaccine Booster Dose Update For additional information, click here.
  • Respiratory Syncytial Virus (RSV) Prophylaxis Season Reopening Across All Regions For additional information, click here.
  • Changes for Client Access to Mosquito Repellent Benefit Begin June 1, 2022 For additional information, click here.
  • Spikevax COVID-19 Vaccine Coverage Update For additional information click here.
  • Members Sought for the Drug Utilization Review Board For additional information click here.
  • Changes for Client Access to Mosquito Repellent Benefit Begin June 1, 2022 For additional information click here.
  • Update to the Pharmacy Procedure Manual Now Available For additional information click here.
  • Second COVID-19 Vaccine Booster Dose Update For additional information click here.
  • Request for Pharmacies to Check That Pharmacy Licenses Are Current in PEMS For additional information click here.
  • April 2022 Drug Utilization Review Board Meeting Summary For additional information click here.
  • Revision to Makena Authorization Request Form Scheduled for June 10, 2022 For additional information click here.
  • January 2022 Preferred Drug List Decisions Now Available For additional information click here.
  • Update to the Pharmacy Procedure Manual Now Available For additional information click here.
  • March 2022 Specialty Drug List Available For additional information click here.
  • Agenda for April Drug Utilization Review Board Meeting Now Available For additional information click here.
  • Pharmacy Education Reminder For additional information click here.
  • Changes for Client Access to Mosquito Repellent Benefit Begin June 1, 2022 For additional information click here.
  • Draft Specialty Drug List Available for Comment For additional information click here.
  • Updates to Phosphate Binder Prior Authorization Criteria Scheduled for April 5, 2022 For additional information click here.
  • Cytokine and CAM Antagonists Criteria Updates Scheduled for April 5, 2022 For additional information click here.
  • Oxbryta Prior Authorization Criteria Updates Scheduled for April 5, 2022 For additional information click here.
  • January 2022 Drug Utilization Review Board Meeting Summary For additional information click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information click here.
  • 2021-22 Respiratory Syncytial Virus (RSV) Season Ends February 1, 2022 For additional information click here.
  • January 2022 Preferred Drug List Now Available For additional information click here.
  • Temporary Change in PDL Status for Tetracyclines Drug Class, Effective January 11, 2022 For additional information click here.
  • Pfizer-BioNTech COVID-19 Booster Update For additional information click here.
  • November 2021 Preferred Drug List Decisions Now Available For additional information click here.
  • Pfizer-BioNTech COVID-19 Vaccine Booster Dose Age Change and New Formulation For additional information click here.
  • Agenda for January Drug Utilization Review Board Meeting Now Available For additional information click here.
  • Managed Care Resources Update For additional information click here.
  • COVID-19 At-home Test Kits Available as a Pharmacy Benefit For additional information click here.
  • Pfizer Oral COVID-19 Drug, Paxlovid, Added to Formulary For additional information click here.
  • Medicaid Pharmacy Benefit Accredited Course, Quick Courses Available For additional information click here.
  • You Can Report Drug Shortages to HHSC For additional information click here.
  • Merck Oral COVID-19 drug, Molnupiravir, Added to Formulary For additional information click here.
  • Change in Age Limit for Pharmacist-Administered Influenza Vaccines For additional information click here.
  • Kidney Health Care Adds New Drugs to Formulary For additional information click here.
  • COVID-19 Vaccine Booster Update For additional information click here.
  • Semi-annual Medicaid Preferred Drug List Update Coming January 27, 2022 For additional information click here.
  • Draft of Medication Therapy Management Policy Available for Comment For additional information click here.
  • Stimate Nasal Spray National Drug Shortage For additional information click here.
  • Pharmacy Services Change of Ownership (CHOW) Interim Process For additional information click here.
  • Promethazine Clinical Prior Authorization Criteria Updates Scheduled for December 7, 2021 For additional information click here.
  • Dupixent Clinical Prior Authorization Criteria Update Scheduled for January 4, 2022 For additional information click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information click here.
  • November 2021 Drug Utilization Review Board Meeting Summary For additional information click here.
  • July 2021 Preferred Drug List Revised December 3, 2021 For additional information click here.
  • Removal of Specialist Requirement from Clinical Prior Authorization Criteria Scheduled for January 3, 2022 For additional information click here.
  • Agenda for November Drug Utilization Review Board Meeting Now Available For additional information click here.
  • Order and Administration of Selected COVID-19 Monoclonal Antibody Therapeutics Reimbursable Through Medicaid Medical Claims System For additional information click here.
  • COVID-19 Vaccine Coverage Update: Comirnaty and Pfizer Age Change For additional information click here.
  • Removal of Specialist Requirement from Clinical Prior Authorization Criteria Scheduled for January 3, 2021 For additional information click here.
  • Coverage of COVID-19 Booster Doses of Moderna and Johnson & Johnson Vaccines For additional information click here.
  • October 2021 NDC-to-HCPCS Crosswalk Now Available For additional information click here.
  • Updates to Medicaid Preferred Drug List Scheduled for November 15, 2021 For additional information click here.
  • Pharmacy Submittal of COVID-19 Vaccine Additional, Booster Doses For additional information click here.
  • Nucala Clinical Prior Authorization Update Scheduled for December 14, 2021 For additional information click here.
  • Repatha (evolocumab) Prior Authorization Update Scheduled for December 6, 2021 For additional information click here.
  • Hepatitis C Drug Rebate Program Procurement Information Now Available For additional information click here.
  • HHSC Updates Respiratory Syncytial Virus (RSV) Season Schedule For additional information click here.
  • HHSC Issues Stromectol (Ivermectin) Guidance For additional information click here.
  • Temporary Change in Texas Pharmacy Prior Authorization Call Center Phone Number For additional information click here.
  • Alinia Clinical Prior Authorization Criteria Revision Effective November 23, 2021 For additional information click here.
  • Updating Pharmacy Claim Systems for COVID-19 Vaccine Additional Doses For additional information click here.
  • 2021-22 RSV Assessment and Synagis Authorization For additional information click here.
  • Changes to Hepatitis C Prior Authorization Criteria Begin September 1, 2021 For additional information click here.
  • Duplicate Therapy Clinical Prior Authorization Criteria Revision Begins October 19, 2021 For additional information click here.
  • Respiratory Syncytial Virus and Synagis Authorization During Summer and Winter 2021-2022 For additional information click here.
  • July 2021 Drug Utilization Review Board Meeting Summary For additional information click here.
  • Atypical Respiratory Syncytial Virus (RSV) Season Advisory For additional information click here.
  • April 2021 Preferred Drug List Decisions Now Available For additional information click here.
  • July 2021 Preferred Drug List Now Available For additional information click here.
  • Changes to Hepatitis C Prior Authorization Criteria Begin September 1, 2021 For additional information click here.
  • Trikafta Age Expansion in Cystic Fibrosis Agents Clinical Prior Authorization Begins September 1, 2021 For additional information click here.
  • Nucala Clinical Prior Authorization Criteria Update Begins July 12, 2021 For additional information click here.
  • Semi-annual Medicaid Preferred Drug List Update Coming July 29, 2021 For additional information click here.
  • HHSC to Reopen RSV Season in Select Regions on June 21, 2021 For additional information click here.
  • Medicaid Allows Pfizer BioNTech COVID-19 Vaccine for Emergency Use in Adolescents For additional information click here.
  • HHSC to Resume Quarterly Specialty Drug List in July 2021 For additional information click here.
  • COVID-19 Testing in Pharmacy Reimbursable Through Medicaid Medical Claims System For additional information click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information click here.
  • April 2021 Preferred Drug List Recommendations Now Available For additional information click here.
  • COVID-19 Vaccine Administration Rate Change Effective April 1, 2021 For additional information click here.
  • January 2021 Preferred Drug List Decisions Now Available For additional information click here.
  • Enzymes Clinical Prior Authorization Criteria Revisions Effective June 30, 2021 For additional information click here.
  • Frequently Asked Questions about the Medicaid Standing Order for Mosquito Repellent For additional information click here.
  • Epidiolex Prior Authorization Revision Scheduled for May 11, 2021 For additional information click here.
  • Medicaid Adds Johnson & Johnson COVID-19 Vaccine to Formulary For additional information click here.
  • Revised Hepatitis C Drug Prior Authorization Form 1342 For additional information click here.
  • January 2021 Preferred Drug List Revised March 5, 2021 For additional information click here.
  • Revisions to Cytokine and CAM Antagonists Prior Authorization Criteria Set for May 4, 2021 For additional information click here.
  • RSV Season Extended for Counties in Southeast Texas and Gulf Coast Areas For additional information click here.
  • Monoclonal Antibody for Asthma Prior Authorization Updates Set for April 6, 2021 For additional information click here.
  • Revised Hepatitis C Drug Prior Authorization Forms Now Available For additional information click here.
  • Clinical Prior Authorization Updates for Cystic Fibrosis Agents For additional information click here.
  • Preferred Drug List Criteria Exception for Macrolides Changes March 15 For additional information click here.
  • Renewed Texas Standing Order for Mosquito Repellent Benefit Available For additional information click here.
  • Clinical Prior Authorization Assistance Chart Now Available For additional information click here.
  • January 2021 Preferred Drug List Now Available For additional information click here.
  • Desmopressin Clinical Prior Authorization Revision Begins March 15, 2021 For additional information click here.
  • COVID-19 Vaccine NDC Update For additional information click here.
  • Dupixent Clinical Prior Authorization Criteria Revision Effective March 15, 2021 For additional information click here.
  • Change to Thiazolidinediones Clinical Prior Authorization Begins February 4, 2021 For additional information click here.
  • Medicaid Adds Moderna COVID-19 Vaccine to Formulary For additional information click here.
  • Medicaid Adds Pfizer BioNTech COVID-19 Vaccine to Formulary For additional information click here.
  • July 2020 Preferred Drug List Revised Dec. 16For additional information click here.
  • Semi-annual Medicaid Preferred Drug List Update Coming Jan. 28, 2021 Preferred drugs are medications recommended by the Texas Drug Utilization Review Board. The Texas Preferred Drug List is published every January and July. For additional information click here.
  • Semi-Annual Preferred Drug List Update Texas Medicaid is updating the Medicaid preferred drug list starting January 30. Visit the Vendor Drug Program website for the changes.
  • Morphine Equivalent Dose Limitations for RightCare to Decrease in January RightCare from Scott and White Health Plan will decrease the daily morphine equivalent dose limit for people enrolled in Medicaid Managed Care on January 1, 2019. The new limit will be set at 90 and will apply to all opioid prescriptions, with exceptions for those people diagnosed with cancer or those receiving palliative or hospice care. Members can call 1-855-897-4448 for assistance.
  • Antipsychotics Clinic Prior Authorization Changes Begin September 1 RightCare from Scott and White Health Plan will revise the antipsychotics clinical prior authorization for people enrolled in Managed Medicaid beginning 9/1/18. To learn more, please review the antipsychotics clinical prior authorization guide (PDF).
  • Notice of Change to Covered Services - Prescribed Pediatric Extended Care Center (PPECC)