Prior Authorization in Texas
Texas enacted SB 1137 (2023) comprehensive PA reform requiring insurers to respond within 5 business days for standard requests and 24 hours for urgent requests. The law also mandates gold card exemptions for physicians with 90%+ PA approval rates and requires peer-to-peer review before PA denials.
Key Facts About PA in Texas
- ✓ Standard PA decisions required within 5 business days; urgent within 24 hours
- ✓ Gold card exemptions for physicians with 90%+ approval rates (effective Sept 2025)
- ✓ Peer-to-peer review required before PA denials
- ✓ Texas Department of Insurance provides external review process
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Texas
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Texas carriers:
BCBS of Texas (HCSC)UnitedHealthcareAetnaCigna