Clinical Prior Authorization Guidelines - UnitedHealthcare Community Plan of Texas

UnitedHealthcare Community Plan’s Clinical Pharmacy Program Guidelines are updated on an ongoing basis by our Pharmacy and Therapeutics Committee. Our changes reflect recent developments in pharmaceutical health care so we’re aligned with national treatment standards.

Clinical Pharmacy Prior Authorization Guidelines

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CHIP Clinical Prior Authorization Guidelines

The following clinical prior authorization guidelines apply to CHIP plans.

STAR, STAR Kids, STAR+PLUS Clinical Prior Authorization Guidelines

Go here to view the most recent Texas Medicaid Preferred Drug List (PDL) and Prior Authorization Criteria (PA). PA Criteria for non-preferred drugs and additional details are on the right side of the PDL chart.
To view the clinical prior authorizations approved for use in Medicaid managed care by the Vendor Drug Program.
The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization UnitedHealthcare uses (as well as by other Managed Care Organizations and those used for traditional Medicaid). This chart is updated quarterly.

These guidelines apply to STAR, STAR Kids and STAR+PLUS plans.