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Pharmacy prior authorization (PA)

When a medication isn't on the preferred drug list (PDL), or has a utilization management requirement, you’ll want to request pharmacy PA. Take a minute to review our current guidelines.

Getting started

Getting started

You’ll need to include the criteria for the drug that you’re requesting PA for. You can visit the Vendor Drug Program’s page for more info about guidelines, including: 


  • Clinical edits for covered drugs
  • Drugs requiring PA
  • PA criteria logic
  • Supporting tables, references and publication history

Electronic PA (ePA)

Electronic PA (ePA)

You need the right tools and technology to help our members. That’s why we’ve partnered with CoverMyMeds® and Surescripts to provide a new way to request pharmacy PA with our ePA program.


With ePA, you can look forward to saving time with:


  • Less paperwork
  • Fewer phone calls and faxes
  • Quicker determinations
  • Safe and secure HIPAA-compliant submitted requests

Enroll now

Getting started with ePA is free and easy. You’ll need this info to enroll:


  • BIN: 610591
  • PCN: ADV
  • Group: RX8801

You can enroll two different ways:

Other ways to request PA


If you don’t want to enroll in ePA, you can request PA:

By phone

You can request PA when you contact us.

By fax

You can download and print the Texas Standard Prior Authorization Form (PDF). Then, fax it with any supporting documentation for a medical necessity review to 1-844-275-1084.

Emergency requests

Federal and Texas state laws require pharmacists to give members their medication without delay after a 72-hour emergency claim.


Learn more about emergency claims

Note: PA requests received by phone will have an immediate approval or denial decision. All other PA requests (urgent and standard) will

receive a decision from us within 24 hours.


You can learn more by visiting our Non-pharmacy prior authorization or Utilization management pages.


Non-pharmacy prior authorization


Utilization management

Also of interest: