Drug Prior Authorization (PA)

Pharmacy Point-of-Sale (POS)

Pharmacy PA (applies to prescription drugs typically dispensed by outpatient pharmacies – (click here for instructions)

Gainwell Technologies handles PA requests for drugs billed through the POS venue. If you are a Mississippi Medicaid prescriber, please submit your PA requests through the Gainwell provider web portal (preferred route) or fax completed PA forms to the number below. The phone number for the Gainwell Pharmacy PA Unit is also listed below.

Universal Preferred Drug List (UPDL) – Click here to access the UPDL.
Non-preferred drugs require PA review for approval. Some preferred products may require PA as indicated on the UPDL.

Other Drugs Requiring PA – Many drugs are covered by Medicaid but are not listed on the UPDL. Click here for a list of drugs not listed on the UPDL that require PA.
Such requests should be submitted using a Universal PA Form.

Select the appropriate PA packet from the drop-down menus below when requesting a PA.

Physician-Administered Drug (PAD) Prior Authorization Instructions

Telligen handles requests for drugs billed on medical claims for fee-for-service members. Please click here to search the Telligen prior authorization portal.

Cell and Gene Therapies for Sickle Cell Disease

The Mississippi Division of Medicaid is participating in the Centers for Medicare and Medicaid Services Cell and Gene Therapy (CGT) Access Model beginning on January 1, 2026. Per the requirements set by this model, prior authorization criteria for each CGT for sickle cell disease are linked below. Please submit the prior authorization request to Telligen if the member is enrolled in fee-for-service or to the member’s respective coordinated care organization.

• CASGEVY PA Criteria
• LYFGENIA PA Criteria

Miscellaneous Forms

Pharmacy Reconsideration Request Form

MedWatch Form