Medicaid (STAR) and CHIP Prior Authorization Forms
- ADD/ADHD
- Agents for Gaucher’s Disease
- Alinia
- Aliskiren-containing Agents
- Allergen extracts
- Altabax
- Amitiza
- Androgens
- Antimetics
- Anti-Influenza Agents
- CGRP Antagonists
- Binge Eating Disorder
- Cablivi
- Carisoprodol
- Chloroquine/Hydroxychloroquine
- CNS Stimulants
- Colchicine Agents
- Colcrys
- Compound Medications
- Contraceptive Coverage Exception
- Cytokine CAM Antagonists
- DPP-4 Inhibitors
- Dispensing Limit Override
- Dupixent
- Elidel Protopic
- Emflaza
- Enzymes
- Erythropoiesis Stimulating Agents
- Flexeril/Amrix
- General Prior Authorization
- GI Motility Agents
- GLP-1 Receptor Agonists
- Glucose Agents
- Growth Hormone
- Hepatitis C
- Hereditary Angioedema
- HP Acthar
- Imiquimod
- Increlex
- Injectable PAH
- Kalydeco Orkambi Symdeko
- Kalydeco Addendum
- Lidoderm Patches
- Lovaza Vascepa
- Makena
- Migraine Agents
- Morphine Equivalent Dose Override
- Opioid Benzodiazepine Pain Therapy
- Opioid Policy
- Orkambi Addendum
- Oxycodone ER
- PDE5-Inhibitors
- Proprotein Convertase Subtilisin Kexin Type 9 (PCSK9) Inhibitors
- Propylthiouracil
- Pulmonary Hypertension Agents
- Ranexa
- Sickle Cell
- Suboxone
- Symlin
- Synagis
- Texas Standard Prior Authorization Request Form for Prescription Drug Benefits (Effective September 1, 2015)
- Trikafta
- Triptan Dihydroergotamine Agents
- VMAT2 Inhibitors
- Xifaxan
- Zelboraf