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 (Revised December 30, 2019)*
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 (Pending March 3, 2020 Implementation) (Revised November 7, 2019)*
Cytokine and CAM Antagonists (Revised September 16, 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 5, 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 (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 (Pending March 3, 2020 Implementation) (Revised January 30, 2020)*
VMAT2 Inhibitors (Revised March 29, 2019)*
Xifaxan (Revised March 29, 2019)*
Xyrem (Revised March 29, 2019)*
Zelboraf (Pending Implementation) (Revised March 29, 2019)*
1 - 95
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