Clinical Criteria
ADD/ADHD Agents (Revised February 10, 2020)*
Alinia (Revised March 21, 2019)*
Aliskiren Containing Agents (Revised March 21, 2019)*
Allergen Extracts (Revised December 10, 2019)*
Altabax (Revised March 21, 2019)*
Androgenic Agents (Pending Implementation) (Revised March 21, 2019)*
Antiemetic Agents (Revised March 21, 2019)*
Antipsychotic Agents (Revised September 4, 2019)*
Anxiolytics and Sedative-Hypnotics (Pending Implementation) (Revised February 18, 2020)*
Anxiolytics and Sedative-Hypnotics (Revised March 22, 2019)*
Arikayce (Pending Implementation) (Revised April 26, 2019)*
Buprenorphine Agents (Revised March 22, 2019)*
Carisoprodol Overuse (Revised March 26, 2019)*
Carisoprodol-Containing Agents (Pending Implementation) (Revised May 23, 2019)*
CGRP Antagonists (Pending Implementation) (Revised August 29, 2019)*
CNS Stimulants (Formerly Provigil and Nuvigil) (Revised March 29, 2019)*
CNS Stimulants (Pending Implementation) (Revised October 29, 2019)*
Colcrys (Pending Implementation) (Revised March 26, 2019)*
Cough & Cold Agents (Revised March 10, 2020)*
COX-2 Inhibitors (Revised January 30, 2020)*
Cyclobenzaprine (Revised March 27, 2019)*
Cymbalta (Pending Implementation) (Revised January 30, 2020)*
Cystic Fibrosis Agents (Revised January 30, 2020)*
Cytokine and CAM Antagonists (Revised November 7, 2019)*
Desmopressin (Revised March 27, 2019)*
Dextromethorphan Overutilization (Revised December 30, 2019)*
Diabetic Test Strips (Pending Implementation) (Revised March 27, 2019)*
Diacomit (Pending Implementation) (Revised November 4, 2019)*
Diclofenac (Pending Implementation) (Revised March 27, 2019)*
Doxylamine/Pyridoxine (Pending Implementation) (Revised October 29, 2019)*
DPP4 Inhibitors (Revised March 27, 2019)*
Drug Regimen Optimization (Pending Implementation) (Revised November 11, 2019)*
Drug Regimen Optimization (Revised September 16, 2019)*
Dupixent (Revised September 13, 2019)*
Duplicate Therapy (Revised January 30, 2020)*
Emflaza (Revised July 3, 2019)*
Enzymes (Revised September 11, 2019)*
Epidiolex (Pending Implementation) (Revised March 28, 2019)*
Erythropoiesis-Stimulating Agents (Revised March 28, 2019)*
Fentanyl Agents (Revised March 28, 2019)*
Forteo (Pending Implementation) (Revised March 28, 2019)*
Gabapentin Agents (Revised March 29, 2019)*
Gaucher's Disease Agents (Pending Implementation) (Revised July 15, 2019)*
GI Motility Agents (Pending Implementation) (Revised July 30, 2019)*
GI Motility Agents (Revised March 29, 2019)*
Glatiramer Acetate Injection (Pending Implementation) (Revised July 15, 2019)*
GLP-1 Receptor Agonists (Revised July 5, 2019)*
Growth Hormone Agents (Pending Implementation) (Revised February 27, 2020)*
Growth Hormone Agents (Revised April 3, 2015)*
Growth Hormone Quick Reference Guide
HAE Agents (Pending Implementation) (Revised July 15, 2019)*
HP Acthar (Revised July 15, 2019)*
Imiquimod (Revised March 29, 2019)*
Increlex (Revised March 29, 2019)*
Inhaled Antibiotics (Pending Implementation) (Revised February 13, 2020)*
Ketorolac (Revised March 29, 2019)*
Keveyis (Pending Implementation) (Revised March 29, 2019)*
Leukotriene Modifiers (Revised July 15, 2019)*
Lidocaine Patches (Revised July 15, 2019)*
Lovaza (Revised March 29, 2019)*
Lyrica (Pending Implementation) (Revised January 30, 2020)*
Makena (Revised May 14, 2019)*
Morphine Milligram Equivalent Criteria (Revised January 30, 2020)*
Nuedexta (Revised March 29, 2019)*
Nuplazid (Pending Implementation) (Revised March 29, 2019)*
Opiate Overutilization (Revised January 30, 2020)*
Opiate/Benzodiazepine/Muscle Relaxant Combinations (Revised January 30, 2020)*
Orilissa (Pending Implementation) (Revised March 29, 2019)*
Oxycontin / Narcotic Analgesic (Revised March 29, 2019)*
PCSK9 Inhibitors (Pending Implementation) (Revised April 6, 2020)*
PCSK9 Inhibitors (Revised March 29, 2019)*
PDE5-Inhibitors (Revised November 8, 2019)*
Phosphate Binders (Revised January 30, 2020)*
Plavix (Pending Implementation) (Revised March 29, 2019)*
Promethazine Utilization (Revised March 29, 2019)*
Propylthiouracil (Revised March 29, 2019)*
Proton Pump Inhibitors (Pending Implementation) (Revised March 29, 2019)*
Pulmonary Hypertension Agents (Pending Implementation) (Revised February 13, 2020)*
Ranexa (Revised March 29, 2019)*
Retinoids (Pending Implementation) (Revised January 30, 2020)*
Savella (Pending Implementation) (Revised March 29, 2019)*
SGLT2 Agents (Pending Implementation) (Revised May 1, 2019)
Sickle Cell Agents (Pending Implementation) (Revised January 30, 2020)*
Symlin (Revised March 29, 2019)*
Synagis (Revised October 4, 2019)*
Thiazolidinediones (Revised March 29, 2019)*
Topical Acne Agents (Pending Implementation) (Revised March 29, 2019)*
Topical Immunomodulators (Revised March 29, 2019)*
Urea Cycle Disorder Agents (Pending Implementation) (Revised April 26, 2019)
Valturna (Retired) (Revised August 23, 2017)*
VMAT2 Inhibitors (Revised January 30, 2020)*
Xifaxan (Revised March 29, 2019)*
Xyrem (Revised March 29, 2019)*
Zelboraf (Pending Implementation) (Revised March 29, 2019)*
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April 2020 Drug Utilization Review Board Meeting Postponed
by TANNER.BAIN on 04/03/2020
The April 24 Texas Drug Utilization Review Board meeting is postponed as a result of the public health concerns with COVID-19 (coronavirus). Rescheduled meeting information will be shared via the VDP website. To learn more, visit
Temporary Change in Status for Inhaled Glucocorticoid, Insulin Hypoglycemics Drug Classes
by TANNER.BAIN on 04/03/2020
VDP temporarily revised the preferred drug list on April 1 to address reported possible drug shortages of products in the inhaled glucocorticoid and hypoglycemic insulin drug classes. The change allows providers to prescribe these drugs without requiring a non-preferred prior authorization and people enrolled in Medicaid continued access to necessary medication. A list of affected drugs is available on the VDP website. To learn more visit
Ranitidine Products Removed from Formulary April 2
by CHRISTINA.FAULKNER on 04/03/2020
On April 1, the FDA requested manufacturers withdraw all ranitidine products (commonly known by the brand name Zantac) from the market because of consumer exposure to unacceptable levels of impurities. VDP removed all ranitidine products from the Medicaid formulary on April 2. A list of removed drugs and formulary alternatives is available on the VDP website. To learn more, visit
Sunosi Criteria Added to Central Nervous System Stimulants Clinical Prior Authorization Starting April 14
by TANNER.BAIN on 03/17/2020
VDP will implement clinical prior authorization criteria for Sunosi (solriamfetol) for traditional Medicaid on April 14. The criteria was approved at the Oct. 2019 Drug Utilization Review Board meeting, and is part of the Central Nervous System Stimulants clinical prior authorization. To learn more, visit:
Latest Information on Coronavirus (COVID-19) from Texas HHS
by CHRISTINA.FAULKNER on 03/11/2020
During a public health threat, HHSC must quickly mobilize to help Texans. Public health threats can affect clients and providers. HHSC has information available for people receiving services and providers to learn about finding help with HHS programs during and after a public health threat. HHSC will update specific information on both pages to ensure accurate information is provided to both clients and providers. To learn more, visit:
New PDL Criteria Checks Stage-four Advanced Metastatic Cancer Diagnosis
by CHRISTINA.FAULKNER on 03/11/2020
Texas Medicaid added new exception criteria to the Jan. 24 preferred drug list to meet the provisions prohibiting health benefit plans from requiring a person to fail to successfully respond to a different drug or prove a history of failure of a different drug prior to covering prescriptions for the treatment of stage-four advanced, metastatic cancer, or for treatment of symptoms or associated conditions. To learn more, visit:
Epinephrine Injection Drug Shortage Impacts Medicaid Non-Preferred Status
by TANNER.BAIN on 02/07/2020
Mylan issued an alert regarding the manufacturing challenges in the production of EpiPen (epinephrine injection, USP) 0.3 mg and EpiPen Jr (epinephrine Injection, USP) 0.15 mg auto-injectors and the authorized generic versions of these strengths. These challenges resulted in the reduced availability of these products. VDP temporarily removed the non-preferred status from the Epinephrine 0.3 mg auto-injector. A list of preferred NDCs is available at
Revised Growth Hormone Clinical Prior Authorization Begins May 28
by TANNER.BAIN on 02/07/2020
The Vendor Drug Program will implement the Growth Hormone clinical prior authorization criteria on May 28 for traditional Medicaid. The prior authorization is optional for Medicaid managed care. To learn more visit
January 2020 Drug Utilization Review Board Meeting Summary
by TANNER.BAIN on 02/07/2020
The Texas Drug Utilization Review Board met Jan. 24, to make recommendations for Medicaid clinical prior authorizations and the preferred drug list. A summary of this meeting is now available from the Texas Vendor Drug Program website at The next meeting is scheduled for Friday, Apr. 24.
Pharmacy Clinical Prior Authorization Assistance Chart Now Available
by TANNER.BAIN on 02/04/2020
There are certain clinical prior authorizations that all MCOs are required to perform. Usage of other clinical prior authorizations will vary between MCOs at the discretion of each MCO. The assistance chart identifies which prior authorizations are utilized by each MCO and how those prior authorizations relate to those used by VDP. Refer to the Vendor Drug Program website at to learn more.
Cystic Fibrosis Agents Clinical Prior Authorization to Include Trikafta Criteria Starting Feb. 24
by TANNER.BAIN on 02/21/2020
VDP will implement the Trikafta criteria within the existing Cystic Fibrosis Agents clinical prior authorization on Feb. 24. This prior authorization is optional for Medicaid managed care. To learn more visit
Austedo Clinical Prior Authorization Criteria Revision Coming March 3
by CHRISTINA.FAULKNER on 01/17/2020
VDP will modify the Austedo prior authorization criteria on March 3. The criteria are included within the existing Vesicular Monoamine Transporter 2 Inhibitors guide, which includes Austedo, Xenazine and Ingrezza. The prior authorization is optional for Medicaid managed care. To learn more, visit the Vendor Drug Program website at
Allergen Extract Clinical Prior Authorization Revision Coming Feb. 24
by TANNER.BAIN on 01/15/2020
VDP will revise the Allergen Extracts clinical prior authorization criteria on Feb. 24 to reflect the Food and Drug Administration guidance expanding the indication for Oralair to people 5 years of age and older. The prior authorization is optional for Medicaid managed care. To learn more visit the VDP website at
Rinvoq Clinical Prior Authorization for Traditional Medicaid Begins March 3
by TANNER.BAIN on 01/15/2020
VDP will implement the Rinvoq (upadacitinib) clinical prior authorization criteria on March 3. The prior authorization is optional for Medicaid managed care. To learn more visit the Vendor Drug Program website at