Clinical Criteria
ADD/ADHD Agents (Pending Implementation) (Revised January 26, 2023)*
ADD/ADHD Agents (Revised December 2, 2021)*
Aliskiren Containing Agents (Pending Implementation) (Revised July 5, 2022)*
Aliskiren Containing Agents (Revised March 21, 2019)*
Allergen Extracts (Pending Implementation) (Revised March 23, 2023)*
Allergen Extracts (Revised December 10, 2019)*
Altabax (Revised July 5, 2022)*
Amantadine ER (Pending Implementation) (Revised October 18, 2022)*
Androgenic Agents (Pending Implementation) (Revised December 20, 2022)*
Antiemetic Agents (Revised July 5, 2022)*
Antifungal Agents, Topical (Pending Implementation) (Revised October 22, 2021)*
Antimigraine Agents, Ergot Derivatives (Revised April 28, 2023)*
Antimigraine Agents, Triptans (Revised February 8, 2023)*
Antipsychotic Agents (Pending Implementation) (Revised June 2, 2022)*
Antipsychotic Agents (Revised February 17, 2021)*
Antiseizure Agents (Diacomit, Epidiolex and Fintepla) (Pending Implementation) (Revised February 8, 2023)*
Anxiolytics and Sedative-Hypnotics (Pending Implementation) (Revised March 27, 2023)*
Anxiolytics and Sedative-Hypnotics (Revised February 4, 2022)*
Arikayce (Pending Implementation) (Revised July 5, 2022)*
Binge Eating Disorder (BED) Agents (Pending Implementation) (Revised November 11, 2021)*
Buprenorphine Agents (Revised February 28, 2023)*
Carisoprodol Overuse (Revised October 20, 2022)*
Carisoprodol-Containing Agents (Pending Implementation) (Revised October 20, 2022)*
CGRP Antagonists, Acute (Revised December 1, 2022)*
CGRP Antagonists, Prophylaxis (Pending Implementation) (Revised May 18, 2023)*
CGRP Antagonists, Prophylaxis (Revised December 1, 2022)*
CNS Stimulants (Pending Implementation) (Revised February 1, 2023)*
CNS Stimulants (Revised October 29, 2019)*
Colchicine (Pending Implementation) (Revised May 24, 2022)*
Cough & Cold Agents (Revised February 28, 2023)*
COX-2 Inhibitors (Revised May 24, 2022)*
Cyclobenzaprine (Revised October 18, 2022)*
Cymbalta (Pending Implementation) (Revised October 18, 2022)*
Cystic Fibrosis Agents (Pending Implementation) (Revised May 4, 2023)*
Cystic Fibrosis Agents (Revised September 21, 2022)
Cytokine and CAM Antagonists (Pending Implementation) (Revised May 19, 2023)*
Cytokine and CAM Antagonists (Revised January 28, 2022)*
Desmopressin (Revised February 1, 2023)*
Dextromethorphan Overutilization (Revised February 28, 2023)*
Diabetic Test Strips (Pending Implementation) (Revised March 27, 2019)*
Diclofenac (Pending Implementation) (Revised October 20, 2022)*
Dopamine Agonists (Pending Implementation) (Revised October 18, 2022)*
Doxylamine/Pyridoxine (Pending Implementation) (Revised October 29, 2019)*
DPP4 Inhibitors (Revised March 27, 2019)*
Drug Regimen Optimization (Retired)*
Duplicate Therapy (Revised November 18, 2022)*
Emflaza (Revised October 7, 2021)*
Enzymes (Revised October 18, 2022)*
Erythropoiesis-Stimulating Agents (Pending Implementation) (Revised April 28, 2023)*
Erythropoiesis-Stimulating Agents (Revised October 28, 2022)*
Evrysdi (Pending Implementation) (Revised June 9, 2022)*
Fentanyl Agents (Revised March 21, 2023)*
Forteo (Pending Implementation) (Revised October 18, 2022)*
Gabapentin Agents (Revised October 28, 2022)*
Gattex (Revised April 28, 2023)*
Gaucher's Disease Agents (Pending Implementation) (Revised December 1, 2022)*
GI Motility Agents (Pending Implementation) (Revised March 22, 2023)*
GI Motility Agents (Revised March 29, 2019)*
Glatiramer Acetate Injection (Pending Implementation) (Revised July 15, 2019)*
GLP-1 Receptor Agonists (Revised April 28, 2023)*
Gonadotropin Releasing Hormone (GnRH) Receptor Antagonists (Pending Implementation) (Revised September 12, 2022)*
Growth Hormone Agents (Pending Implementation) (Revised June 8, 2022)*
Growth Hormone Agents (Revised January 12, 2022)*
Growth Hormone Quick Reference Guide
HAE Agents (Revised March 23, 2023)*
Hemady (Pending Implementation) (Revised October 28, 2022)*
HP Acthar (Pending Implementation) (Revised December 2, 2022)*
HP Acthar (Revised July 15, 2019)*
Hyperlipidemia Agents (Revised October 7, 2021)*
Ileal Bile Acid Transporter (IBAT) Inhibitors (Formerly Cholestatic Pruritis Agents) (Pending Implementation) (Revised March 30, 2023)*
Imiquimod (Revised October 19, 2022)*
Immunomodulator Agents for Dry Eye (Formerly Ophthalmic Immunomodulators) (Pending Implementation) (Revised April 28, 2022)*
Increlex (Revised October 19, 2022)*
Inhaled Antibiotics (Revised October 28, 2022)*
Ketorolac (Revised February 10, 2023)*
Keveyis (Pending Implementation) (Revised October 28, 2022)*
Leukotriene Modifiers (Revised December 2, 2022)*
Lidocaine Patches (Pending Implementation) (Revised January 17, 2023)*
Lupus Agents (Pending Implementation) (Revised October 22, 2021)*
Lyrica (Pending Implementation) (Revised March 7, 2022)*
Monoclonal Antibody Agents (Pending Implementation) (Revised March 23, 2023)*
Monoclonal Antibody Agents (Revised August 9, 2021)*
Monoclonal Antibody Agents - Dupixent (Revised March 10, 2022)*
Multiple Sclerosis Agents (Pending Implementation) (Revised January 20, 2023)*
Nitazoxanide (Formerly Alinia) (Revised September 7, 2021)*
Nitazoxanide (Pending Implementation) (Revised May 24, 2022)*
Nuedexta (Revised November 11, 2021)*
Nuplazid (Pending Implementation) (Revised March 29, 2019)*
Omega-3 Fatty Acids (Revised January 3, 2023)*
Opiate Overutilization (Revised March 22, 2023)*
Opiate/Benzodiazepine/Muscle Relaxant Combinations (Pending Implementation) (Revised February 28, 2023)*
Opiate/Benzodiazepine/Muscle Relaxant Combinations (Revised December 15, 2022*)
Orilissa (Pending Implementation) (Revised March 29, 2019)*
Oxervate (Pending Implementation) (Revised December 2, 2022)*
Oxycodone Extended-Release Agents (Revised March 22, 2023)*
Palforzia (Pending Implementation) (Revised October 19, 2022)*
PDE5-Inhibitors (Revised May 15, 2023)*
Phosphate Binders (Revised February 1, 2023)*
Plavix (Pending Implementation) (Revised March 29, 2019)*
Preferred Drug List (January 2023)
Promethazine Utilization (Revised October 19, 2022)*
Propylthiouracil (Revised October 31, 2022)*
Proton Pump Inhibitors (Pending Implementation) (Revised March 29, 2019)*
Pulmonary Hypertension Agents (Pending Implementation) (Revised May 18, 2023)*
Pulmozyme (Pending Implementation) (Revised January 24, 2022)*
Ranexa (Revised October 31, 2022)*
Recorlev (Pending Implementation) (Revised April 22, 2022)*
Recurrent Vulvovaginal Candidiasis (RVVC) Agents (Vivjoa) (Pending Implementation) (Revised October 22, 2022)*
Retinoids (Pending Implementation) (Revised July 19, 2021)*
Savella (Pending Implementation) (Revised March 29, 2019)*
SGLT2 Agents (Revised February 1, 2023)*
Sickle Cell Agents (Revised October 19, 2022)*
Symlin (Revised March 29, 2019)*
Synagis (Revised September 15, 2022)*
Thiazolidinediones (Revised November 11, 2020)*
Topical Acne Agents (Pending Implementation) (Revised July 19, 2021)*
Topical Immunomodulators (Pending Implementation) (Revised May 17, 2023)*
Topical Immunomodulators (Revised June 24, 2020)*
Transthyretin Agents (Pending Implementation) (Revised October 8, 2021)*
Urea Cycle Disorder Agents (Pending Implementation) (Revised April 26, 2019)
Valturna (Retired) (Revised August 23, 2017)*
VMAT2 Inhibitors (Revised October 15, 2021)*
Voxzogo (Pending Implementation) (Revised April 22, 2022)*
Xifaxan (Revised March 29, 2019)*
Xyrem (Revised October 8, 2021)*
Xyrem/Xywav (Pending Implementation) (Revised October 8, 2021)*
Zelboraf (Revised October 8, 2021)*
Ztalmy (Pending Implementation) (Revised January 20, 2023)*
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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
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
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
Temporary Change in PDL Status for the Neuropathic Pain Drug Class Effective April 3
by CHRISTINA.FAULKNER on 04/07/2023
Effective April 3, 2023, the Texas Health and Human Services Commission (HHSC) has temporarily removed the non-preferred status from the generic product lidocaine 5% patch on the preferred drug list (PDL). (The lidocaine patch 5% is in the neuropathic pain drug class.) This temporary removal is in response to the shortage of the preferred brand name product Lidoderm 5% patch, which the manufacturer discontinued. Note: The preferred status of the brand name product Lidoderm (NDC 63481-0687-06) will not change so that any available existing stock can be used. To learn more, visit
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
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
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
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
Revision of Olumiant Clinical Prior Authorization Criteria Scheduled for March 27
by CHRISTINA.FAULKNER on 03/23/2023
On March 27, 2023, HHSC will revise the clinical prior authorization criteria for Olumiant. Olumiant is a Janus kinase inhibitor approved and prescribed for adults with severe alopecia areata and moderate to severe active rheumatoid arthritis. These revisions are required to match the current prior authorization criteria with the information in the product package. The Olumiant criteria in the Cytokine and CAM Antagonists prior authorization clinical criteria guide is optional for MCOs.To learn more, visit
Respiratory Syncytial Virus (RSV) Season Ends on March 1
by TALESHIA.CORE on 02/15/2023
HHSC will close the RSV season’s Synagis prophylaxis therapy in all regions on March 1, 2023. HHSC based this decision on the Texas RSV task force and HHSC Office of the Medical Director recommendation because of the continued decrease in RSV test positivity below the threshold for two consecutive weeks. HHSC will continue to monitor RSV across the state and notify the public about any updates needed to access Synagis prophylaxis treatment. To learn more, visit
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