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HHSC To Implement Clinical Prior Authorizations For Fee-For-Service on Oct. 31
by CHRISTINA.FAULKNER on 08/31/2023
HHSC has reviewed and will update some clinical prior authorization criteria guides on October 31, 2023. These clinical prior authorizations are optional for the MCOs.
To learn more, visit txvendordrug.com/about/news.
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Reminder: Client Access to Mosquito Repellents Available Through Pharmacy
by TALESHIA.CORE on 07/21/2023
The Centers for Disease Control and Prevention reported in June about locally acquired malaria cases being identified in Texas. To prevent and control the spread of malaria and other mosquito-borne diseases in Texas, HHSC reminds providers of the mosquito repellent pharmacy benefit. HHSC covers mosquito repellents year-round for the prevention of mosquito-borne diseases for clients enrolled in Medicaid, the Children's Health Insurance Program (CHIP), the Children with Special Health Care Needs (CSHCN) Services Program, and the Healthy Texas Women (HTW) Program. Coverage of mosquito repellent is limited to two cans or bottles per calendar month, and all programs require a prescription. Clients can contact their healthcare provider to obtain a prescription for mosquito repellent. To learn more, visit txvendordrug.com/about/news. |
Clinical Prior Authorizations Updates and Implementations for Fee-For-Service
by CHRISTINA.FAULKNER on 06/20/2023
On July 27, 2023, HHSC will implement updates for Cytokine and CAM Antagonists, Pulmonary Hypertension Agents, and Topical Immunomodulators clinical prior authorizations. Additionally, HHSC will revise the Calcitonin Gene-Related Peptide Receptor (CGRP) Antagonists, Prophylaxis prior authorization criteria.
The implementation will include the following updates:
• Cytokine and CAM Antagonists:
o Adding the prior authorization criteria for Sotyktu as approved by the Drug Utilization Review (DUR) Board in April 2023
o Adding Amjevita (a Humira biosimilar product) to the Humira and Biosimilar to the Drugs Requiring Prior Authorization table
• Pulmonary Hypertension Agents:
o Adding epoprostenol and Orenitam ER to the list of drugs requiring prior authorization.
• Topical Immunomodulators:
o Adding a check for the application site for Elidel and Protopic 0.3% approval if applied to thin skinned area such as the eyelids.
o Updating the approval timeframe for Opzelura to 180 days
As a reminder, HHSC will implement Qulipta in the CGRP Antagonists, Prophylaxis prior authorization on June 27. For the latest version of the criteria guide, please visit the following link: paxpress.txpa.hidinc.com/cgrpchronicpdg.pdf.
These clinical prior authorizations are optional for MCOs. The Pharmacy Clinical Prior Authorization Assistance Chart chart shows which clinical prior authorizations each MCO uses and whether the MCO uses all or some of the steps in the prior authorization evaluation process. This chart is updated quarterly. Providers can refer to the MCO Resources page at txvendordrug.com/resources/mco-search for links to each MCO’s list of clinical prior authorizations.
To learn more, visit txvendordrug.com/about/news.
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Semi-annual Medicaid Preferred Drug List Update Coming July 27
by CHRISTINA.FAULKNER on 06/15/2023
Texas Medicaid will publish the semi-annual update of the Medicaid preferred drug list on July 27. HHSC made the PDL changes based on recommendations made at the January and April 2023 Texas Drug Utilization Review Board meetings.
To learn more, visit txvendordrug.com/about/news.
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Removal of Quantity Limits for Hepatitis C Medications, Including Mavyret Preferred Hepatitis C Treatment
by TALESHIA.CORE on 05/31/2023
On May 25, 2023, HHSC changed the quantity limit on direct-acting antiviral drugs for treating Hepatitis C. This change applies to all Medicaid clients in managed care and fee-for-service.
To learn more, visit txvendordrug.com/about/news. |
Clinical Prior Authorization Criteria for Calcitonin Gene-Related Peptide Receptor Antagonists Effective April 4
by CHRISTINA.FAULKNER on 03/23/2023
On April 4, 2023, HHSC will implement clinical prior authorization criteria for the treatment of calcitonin gene-related peptide receptor (CGRP) antagonists for Medicaid fee-for-service clients. The prior authorization criteria relate to Nurtec orally disintegrating tablets (ODT) and Ubrelvy, which are approved for treating acute migraines. This prior authorization is optional for MCOs. To learn more, visit txvendordrug.com/about/news.
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HHSC To Revise Livmarli Criteria On May 30
by CHRISTINA.FAULKNER on 04/07/2023
On May 30. 2023, HHSC will update the Livmarli criteria, part of the Cholestatic Pruritis prior authorization, to allow coverage for pediatric patients three months and older. Originally, Livmarli was approved for pediatric patients aged one and older. The Cholestatic Pruritis prior authorization is optional for MCOs.
To learn more, visit txvendordrug.com/about/news.
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Hereditary Angioedema Agents Clinical Prior Authorization Effective for Medicaid Fee-for-Service on April 11
by CHRISTINA.FAULKNER on 03/30/2023
On April 11, 2023, HHSC will implement the Hereditary Angioedema (HAE) Agents (PDF) clinical prior authorization for clients who are enrolled in Medicaid fee-for-service. This clinical prior authorization is optional for Medicaid managed care organizations (MCOs). To learn more, visit txvendordrug.com/about/news.
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Enzymes Clinical Prior Authorization Effective for Medicaid Fee-for-Service on April 18
by CHRISTINA.FAULKNER on 03/30/2023
On April 18, 2023, HHSC will implement the enzymes clinical prior authorization for clients who are enrolled in Medicaid fee-for-service. This clinical prior authorization is optional for Medicaid managed care organizations (MCOs). To learn more, visit txvendordrug.com/about/news.
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Implementation of Inhaled Antibiotics Clinical Prior Authorization for Medicaid Fee-For-Service Set for May 2
by CHRISTINA.FAULKNER on 03/23/2023
On May 2, 2023, HHSC will implement the inhaled antibiotics clinical prior authorization for clients enrolled in Medicaid fee-for-service.
This prior authorization is optional for MCOs.
To learn more, visit txvendordrug.com/about/news.
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Revisions To Antimigraine Agents (Triptans) Clinical Prior Authorization Criteria Scheduled for April 4
by CHRISTINA.FAULKNER on 03/23/2023
On April 4, 2023, HHSC will revise the clinical prior authorization criteria for antimigraine agents (triptans). This revision will add a step to check for the maximum dose per 30 days of therapy as stated in the products' package inserts for established drug safety dosing.
This prior authorization is optional for MCOs.
To learn more, and see a list of affected drugs, visit txvendordrug.com/about/news.
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Changes to Lovaza Clinical Prior Authorization Scheduled for March 21, 2023
by TALESHIA.CORE on 01/19/2023
On March 21, HHSC will make revise the Lovaza prior authorization criteria, including changing its name to Omega-3 Fatty Acids. A list of changes is available on the Vendor Drug Program website. This clinical prior authorization is optional for managed care organizations.
To learn more, visit txvendordrug.com/about/news. |