Learn about the Medicaid 1115 Transformation Waiver Renewal.
For information about COVID-19, call 2-1-1 and select Option 6.
Find a COVID-19 testing site | COVID-19 vaccine | More COVID-19 information
Some forms cannot be viewed in a web browser and must be opened in Adobe Reader on your desktop system. Click here for instructions on accessing your form.
For prescribing providers to request pharmacy prior authorization for Increlex® (mecasermin).
When to Prepare
- Only use this form for people enrolled in Medicaid fee-for-service.
- The prescribing provider should sign and submit all requests. Please complete all requested information or document why information is not available.
- This addendum must accompany the Texas Department of Insurance Standard Prior Authorization Form (TDI Form NOFR002) (PDF).
- Staff sends the form to the Medicaid-enrolled pharmacy, who then forwards the completed form by fax.
- Fax: 866-469-8590
- Direct questions about this form to the Texas Prior Authorization Call Center at 877-PA-TEXAS (877-728-3927).