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 July 15, 2020)*
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)*
Binge Eating Disorder (BED) Agents (Pending Implementation) (Revised October 23, 2020)*
Buprenorphine Agents (Revised March 22, 2019)*
Carisoprodol Overuse (Revised March 26, 2019)*
Carisoprodol-Containing Agents (Pending Implementation) (Revised May 23, 2019)*
CGRP Antagonists, Acute (Pending Implementation) (Revised October 28, 2020)*
CGRP Antagonists, Chronic (Pending Implementation) (Revised August 29, 2019)*
CNS Stimulants (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 (Pending Implementation) (Revised December 31, 2020)
Cystic Fibrosis Agents (Revised October 19, 2020)
Cytokine and CAM Antagonists (Pending Implementation (Revised August 27, 2020)*
Cytokine and CAM Antagonists (Revised November 7, 2019)*
Desmopressin (Pending Implementation March 15, 2021) (Revised December 21, 2020)*
Desmopressin (Revised March 27, 2019)*
Dextromethorphan Overutilization (Revised December 30, 2019)*
Diabetic Test Strips (Pending Implementation) (Revised March 27, 2019)*
Diacomit (Pending Implementation) (Revised August 20, 2020)*
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 (Pending Implementation March 15, 2021) (Revised January 6, 2021)
Dupixent (Revised June 17, 2020)*
Duplicate Therapy (Revised July 15, 2020)*
Emflaza (Revised July 3, 2019)*
Enzymes (Revised September 11, 2019)*
Epidiolex (Pending Implementation) (Revised August 20, 2020)*
Erythropoiesis-Stimulating Agents (Revised October 7, 2020)*
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 15, 2020)*
Growth Hormone Agents (Revised February 20, 2020)*
Growth Hormone Quick Reference Guide
HAE Agents (Pending Implementation) (Revised July 15, 2019)*
HP Acthar (Pending Implementation) (Revised July 24, 2020)*
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 (Pending Implementation) (Revised July 15, 2019)*
Lovaza (Revised March 29, 2019)*
Lyrica (Pending Implementation) (Revised June 26, 2020)*
Makena (Revised May 14, 2019)*
Monoclonal Antibody Agents for Asthma (Pending Implementation) (Revised May 26, 2020)
Nuedexta (Revised March 29, 2019)*
Nuplazid (Pending Implementation) (Revised March 29, 2019)*
Ophthalmic Immunomodulators (Pending Implementation) (Revised June 30, 2020)*
Opiate Overutilization (Pending Implementation September 1, 2020) (Revised July 27, 2020)*
Opiate Overutilization (Revised January 30, 2020)*
Opiate/Benzodiazepine/Muscle Relaxant Combinations (Revised January 30, 2020)*
Opioid Policy Criteria (Formerly MME criteria) (Revised July 20, 2020)*
Oriahnn (Pending Implementation) (Revised October 28, 2020)*
Orilissa (Pending Implementation) (Revised March 29, 2019)*
Oxervate (Pending Implementation) (Revised July 24, 2020)*
Oxycontin / Narcotic Analgesic (Revised March 29, 2019)*
Palforzia (Pending Implementation) (Revised August 24, 2020)*
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 July 15, 2020)*
Savella (Pending Implementation) (Revised March 29, 2019)*
SGLT2 Agents (Pending Implementation) (Revised May 1, 2019)
Sickle Cell Agents (Revised January 30, 2020)*
Symlin (Revised March 29, 2019)*
Synagis (Revised August 11, 2020)*
Thiazolidinediones (Pending Implementation February 4, 2021) (Revised November 11, 2020)*
Thiazolidinediones (Revised March 29, 2019)*
Topical Acne Agents (Pending Implementation) (Revised March 29, 2019)*
Topical Immunomodulators (Revised June 24, 2020)*
Transthyretin Agents (Pending Implementation) (Revised April 24, 2020)
Urea Cycle Disorder Agents (Pending Implementation) (Revised April 26, 2019)
Valturna (Retired) (Revised August 23, 2017)*
VMAT2 Inhibitors (Revised June 24, 2020)*
Wakix (Pending Implementation) (Revised October 28, 2020)*
Xifaxan (Revised March 29, 2019)*
Xyrem (Revised March 29, 2019)*
Xyrem/Xywav (Pending Implementation) (Revised October 28, 2020)*
Zelboraf (Pending Implementation) (Revised March 29, 2019)*
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Agenda for January Drug Utilization Review Board Meeting Available
by TANNER.BAIN on 01/07/2021
HHSC published the agenda for the Friday, January 22, 2021, Texas Drug Utilization Review Board meeting. Also available are instructions for submitting written materials to the board before the meeting and testifying in person. To learn more, visit
Desmopressin Clinical Prior Authorization Revision Scheduled for March 15, 2021
by TANNER.BAIN on 01/04/2021
On March 15, 2021, HHSC will revise the desmopressin clinical prior authorization by removing the hyponatremia denial criteria. The change will allow approval for people whose hyponatremia has been resolved. This clinical prior authorization is optional for MCOs. To learn more, visit
Semi-annual Medicaid Preferred Drug List Update Coming January 28
by TANNER.BAIN on 12/30/2020
Texas Medicaid will publish the semi-annual update of the Medicaid preferred drug list on Jan. 28. HHSC made the PDL changes based on recommendations made at the July and Oct. 2020 Texas Drug Utilization Review Board meetings. To learn more, visit
Change to Thiazolidinedione Clinical Prior Authorization Begins February 4
by TANNER.BAIN on 12/02/2020
Beginning February 4, 2021, Texas Medicaid will no longer subject Oseni, a combination of Thiazolidinediones (TZD) and Dipeptidyl Peptidase-4 inhibitor drug, to the TZD clinical prior authorization criteria. Oseni is not recommended for patients with severe renal impairment or end-stage renal disease requiring dialysis. Therefore, the TZD criteria are deemed inappropriate for this drug. Oseni will continue to be subject to the Dipeptidyl Peptidase-4 Inhibitors clinical prior authorization criteria. This prior authorization is optional for use in Medicaid managed care. To learn more, visit
Dupixent Clinical Prior Authorization Criteria Revision Effective March 15
by TANNER.BAIN on 01/14/2021
On March 15, 2021, VDP will revise the Dupixent clinical prior authorization. Dupixent is FDA-approved for multiple indications, including the treatment of atopic dermatitis. VDP will update the current clinical prior authorization criteria for atopic dermatitis treatment to better align with the Preferred Drug List criteria. To learn more, visit
Revision to Kalydeco Clinical Prior Authorization Begins Dec. 28
by TANNER.BAIN on 11/20/2020
Medicaid will revise the Kalydeco clinical prior authorization criteria to allow children aged four months and older to meet the gene mutation approval criteria to receive treatment. To learn more, visit
Branded Concerta Tablets Return to Non-Preferred Status on Oct. 16
by TANNER.BAIN on 09/18/2020
VDP temporarily removed the non-preferred status for brand Concerta products in the Stimulants drug class on April 23 in response to reported drug shortages. VDP will reverse this change in status on Oct. 16 because of sufficient product availability. A list of affected NDCs is available from the VDP website. To learn more, visit
Epidiolex and Diacomit Clinical Prior Authorization Criteria Updates
by TANNER.BAIN on 09/09/2020
VDP regularly updates the clinical prior authorization criteria. These updates are necessary to help align VDP drug policies and prior authorization approval criteria with the latest information available on drug information packets, the federal or state regulations. On Oct. 1, 2020, ICD-10 code G40.83 becomes available for Dravet Syndrome. Also, on July 31, 2020, the FDA approved Epidiolex for the treatment of seizures associated with tuberous sclerosis complex in patients one year of age and older. Updates to clinical prior authorization criteria documents were made to reflect these changes. To learn more, visit
October 2020 Drug Utilization Review Board Meeting Summary
by TANNER.BAIN on 11/06/2020
The Texas Drug Utilization Review Board met on Friday, Oct. 23, to make recommendations for Medicaid clinical prior authorizations and the preferred drug list. A summary of this meeting is now available. The board next meets on Friday, Jan. 22. To learn more, visit
Change to Macrolide Preferred Drug List Prior Authorization Duration Set for Sept. 15
by TANNER.BAIN on 07/22/2020
On Sept 15, 2020, VDP will extend the non-preferred prior authorization duration for macrolides from 30 days to 90 days for people with a diagnosis of Gastroparesis, Cerebral Palsy Gastroparesis, or GERD Gastrostomy complications. This will accommodate longer-term prescribing for such conditions. MCOs are required to comply with this PDL prior authorization criteria, including duration. To learn more, visit
Clinical Prior Authorization for Oxbryta in Traditional Medicaid Begins Sept. 8
by CHRISTINA.FAULKNER on 06/12/2020
VDP will implement the clinical prior authorization criteria for Oxbryta (voxelotor) for traditional Medicaid on Sept. 8. The Texas Drug Utilization Review Board approved Oxbryta as part of the Sickle Cell Disease Agents criteria at its Jan. 2020 meeting. This prior authorization is optional for Medicaid managed care. To learn more, visit
PCSK9 Clinical Prior Authorization Criteria Changes To Begin July 7
by TANNER.BAIN on 04/17/2020
VDP will revise the clinical prior authorization criteria for protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on July 7. To learn more visit