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Hepatitis C Treatment Coverage and PDL Update Scheduled for September 1
by TALESHIA.CORE on 08/12/2022
Beginning September 1, 2022, Texas Medicaid will designate one medication as the primary preferred direct-acting antiviral (DAA) drug option for treating Hepatitis C infection. HHSC will designate all other DAA drugs on the Medicaid formulary as non-preferred.
All Medicaid clients are eligible for DAA treatment with the primary preferred agent regardless of the client’s METAVIR fibrosis score, and prior authorization is not required. Any enrolled Medicaid provider can prescribe the preferred drug, and a drug screening is not required.
HHSC will publish an update to the Texas Medicaid Preferred Drug List (PDL) on September 1, 2022, to designate preferred and non-preferred options for DAA treatment. Drugs identified on the PDL as preferred are available without prior authorization.
To learn more, visit txvendordrug.com/about/news. |
Respiratory Syncytial Virus (RSV) Prophylaxis Season Reopening Across All Regions
by CHRISTINA.FAULKNER on 05/25/2022
The Texas Health and Human Services Commission (HHSC) is aware of a summertime RSV resurgence in multiple regions across the state. In response to the RSV activity and consultation with medical experts from across the state, HHSC will take necessary action to prevent the further spread of RSV by reopening all regions to monthly administration of palivizumab (Synagis) prophylaxis to eligible members, beginning June 1, 2022. Providers may start monthly palivizumab (Synagis) prophylaxis treatment for all eligible members starting as early as June 1. To learn more, visit txvendordrug.com/about/news. |
April 2022 Drug Utilization Review Board Meeting Summary
by CHRISTINA.FAULKNER on 05/05/2022
The Texas Drug Utilization Review Board met Friday, April 22, to make recommendations about clinical prior authorizations and drugs on the Texas Medicaid Preferred Drug List. To learn more, visit txvendordrug.com/about/news. |
Clinical Prior Authorization Criteria Updates for Dupixent, Evrysdi, and Qelbree
by TALESHIA.CORE on 07/01/2022
HHSC revised the following clinical prior authorization criteria guides to reflect the recent recommendations from the recent U.S. Food and Drug Administration (FDA) approved indications:
• Dupixent (Dupilumab) in the Monoclonal Antibody Agents clinical prior authorization
• Evrysdi (Risdiplam)
• Qelbree (Vilozazine) in the Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) Medications prior authorization
These clinical prior authorizations are not yet applicable to fee-for-service and are optional for managed care. To learn more, visit txvendordrug.com/about/news. |
March 2022 Specialty Drug List Available
by CHRISTINA.FAULKNER on 03/30/2022
The March 2022 biannual Specialty Drug List is now available. The SDL includes drugs MCOs may exclusively provide through their specialty pharmacy network. To learn more, visit txvendrodrug.com/about/news. |
Changes for Client Access to Mosquito Repellent Benefit Begin June 1
by TALESHIA.CORE on 02/24/2022
Beginning May 31, 2022, HHSC will stop using the Texas Medicaid Standing Order for Mosquito Repellent. Pharmacies must obtain a prescription from a Medicaid-enrolled prescribing provider to dispense mosquito repellent beginning June 1, 2022, for Medicaid, Children’s Health Insurance Program (CHIP), and Healthy Texas Women (HTW). HHSC has extended the effective date of the current standing order until May 31, 2022, to ensure providers have adequate notice regarding upcoming changes to the mosquito repellent benefit. To learn more, visit txvendordrug.com/about/news. |
Oxbryta Prior Authorization Criteria Updates Scheduled for April 5
by TALESHIA.CORE on 02/17/2022
On April 5, 2022, HHSC will revise the prior authorization criteria in the Sickle Cell Disease Agents clinical prior authorization for Oxbryta (voxelotor) to ensure alignment with the US Food and Drug Administration-approved indications and package inserts. The criteria update includes the FDA’s recent age expansion to 4 years and older, and the removal of criteria step 6 relating to the drug interaction with CYP3A4 inhibitors or fluconazole. The updated criteria guide document also includes pediatric dosing information tables. This clinical prior authorization remains optional for managed care. To learn more, visit txvendordrug.com/about/news. |
Cytokine and CAM Antagonists Criteria Updates Scheduled for April 5
by CHRISTINA.FAULKNER on 02/16/2022
On April 5, 2022, HHSC will make the following revisions to various medications within the Cytokine and CAM Antagonists clinical prior authorization criteria to ensure alignment with US Food and Drug Administration approved indications. This clinical prior authorization remains optional for managed care. To learn more, visit txvendordrug.com/about/news. |
Updates to Phosphate Binder Prior Authorization Criteria Scheduled for April 5
by CHRISTINA.FAULKNER on 02/16/2022
On April 5, 2022, HHSC will revise the phosphate binder non-preferred prior authorization criteria by transferring specific criteria to the phosphate binders clinical prior authorization. This update correlates with the recent Texas Drug Utilization Review Board-approved revisions to the phosphate binder clinical prior authorization criteria. In this process, HHSC will also rearrange some of the steps to help improve the way each step flows into the next. The changes to the non-preferred prior authorization criteria are mandatory for MCOs. The phosphate binders clinical prior authorization remains optional for managed care. To learn more, visit txvendordrug.com/about/news. |