Clinical Criteria
ADD/ADHD Agents (Pending Implementation) (Revised September 14, 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 January 9, 2024)*
Allergen Extracts (Revised December 10, 2019)*
ALS Agents (Pending Implementation) (Revised July 21, 2023)*
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 December 8, 2023)*
Antimigraine Agents, Ergot Derivatives (Revised January 9, 2024)*
Antimigraine Agents, Triptans (Pending Implementation) (Revised January 26, 2024)*
Antimigraine Agents, Triptans (Revised November 9, 2023)*
Antipsychotic Agents (Pending Implementation) (Revised January 26, 2024)*
Antipsychotic Agents (Revised October 13, 2023)*
Antiseizure Agents (Diacomit, Epidiolex, and Fintepla) (Pending Implementation) (Revised December 8, 2023)*
Anxiolytics and Sedative-Hypnotics (Pending Implementation) (Revised January 9, 2024)*
Anxiolytics and Sedative-Hypnotics (Revised July 18, 2023)*
Arikayce (Pending Implementation) (Revised July 5, 2022)*
Binge Eating Disorder (BED) Agents (Pending Implementation) (Revised November 11, 2021)*
Buprenorphine Agents (Revised December 8, 2023)*
Carisoprodol Overuse (Revised October 20, 2022)*
Carisoprodol-Containing Agents (Pending Implementation) (Revised October 30, 2023)*
CGRP Antagonists, Acute (Pending Implementation) (Revised January 9, 2024)*
CGRP Antagonists, Acute (Revised December 1, 2022)*
CGRP Antagonists, Prophylaxis (Revised January 9, 2024)*
CNS Stimulants (Pending Implementation) (Revised October 30, 2023)*
CNS Stimulants (Revised October 29, 2019)*
Colchicine (Pending Implementation) (Revised January 26, 2024)*
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 (Revised December 8, 2023)*
Cytokine and CAM Antagonists (Pending Implementation) (Revised February 13, 2024)*
Cytokine and CAM Antagonists (Revised August 11, 2023)*
Daybue (Pending Implementation) (Revised July 21, 2023)*
Desmopressin (Revised February 1, 2023)*
Dextromethorphan Overutilization (Revised December 8, 2023)*
Diabetic Test Strips (Pending Implementation) (Revised March 27, 2019)*
Diclofenac (Pending Implementation) (Revised October 30, 2023)*
Dopamine Agonists (Pending Implementation) (Revised October 18, 2022)*
Doxylamine/Pyridoxine (Pending Implementation) (Revised December 8, 2023)*
DPP4 Inhibitors (Revised December 8, 2023)*
Drug Regimen Optimization (Retired)*
Duplicate Therapy (Revised November 30, 2023)*
Emflaza (Revised December 8, 2023)*
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)*
Filspari (Pending Implementation) (Revised October 13, 2023)*
FMT Agents (Pending Implementation) (Revised July 26, 2023)*
Forteo (Pending Implementation) (Revised October 18, 2022)*
Gabapentin Agents (Revised October 30, 2023)*
Gattex (Revised April 28, 2023)*
Gaucher's Disease Agents (Revised January 9, 2024)*
GI Motility Agents (Revised October 10, 2023)*
Glatiramer Acetate Injection (Pending Implementation) (Revised January 9, 2024)*
GLP-1 Receptor Agonists (Revised August 9, 2023)*
Gonadotropin Releasing Hormone (GnRH) Receptor Antagonists (Pending Implementation) (Revised September 12, 2022)*
Growth Hormone Agents (Pending Implementation) (Revised July 21, 2023)*
Growth Hormone Agents (Revised January 12, 2022)*
Growth Hormone Quick Reference Guide
HAE Agents (Revised January 11, 2024)*
Hemady (Pending Implementation) (Revised October 30, 2023)*
Hormonal Therapy Agents (Pending Implementation March 1, 2024) (Revised December 26, 2023)*
HP Acthar (Pending Implementation) (Revised December 2, 2022)*
HP Acthar (Revised January 9, 2024)*
Hyperlipidemia Agents (Revised January 9, 2024)*
Ileal Bile Acid Transporter (IBAT) Inhibitors (Pending Implementation) (Revised January 9, 2024)*
Imcivree (Pending Implementation) (Revised October 13, 2023)*
Imiquimod (Revised December 13, 2023)*
Immunomodulator Agents for Dry Eye (Formerly Ophthalmic Immunomodulators) (Pending Implementation) (Revised April 28, 2022)*
Increlex (Revised October 19, 2022)*
Inhaled Antibiotics (Revised October 31, 2023)*
Ketorolac (Revised October 31, 2023)*
Keveyis (Pending Implementation) (Revised October 31, 2023)*
Leukotriene Modifiers (Revised January 9, 2024)*
Lidocaine Patches (Pending Implementation) (Revised January 9, 2024)*
Lupus Agents (Pending Implementation) (Revised October 22, 2021)*
Lyrica (Pending Implementation) (Revised December 8, 2023)*
Monoclonal Antibody Agents (Pending Implementation (Revised January 10, 2024)*
Monoclonal Antibody Agents (Revised August 9, 2021)*
Monoclonal Antibody Agents - Dupixent (Revised March 10, 2022)*
Multiple Sclerosis Agents (Pending Implementation) (Revised June 1, 2023)*
Nitazoxanide (Formerly Alinia) (Revised September 7, 2021)*
Nitazoxanide (Pending Implementation) (Revised May 24, 2022)*
Nuedexta (Revised November 11, 2021)*
Nuplazid (Pending Implementation) (Revised December 8, 2023)*
Omega-3 Fatty Acids (Revised September 13, 2023)*
Opiate Overutilization (Revised November 8, 2023)*
Opiate/Benzodiazepine/Muscle Relaxant Combinations (Pending Implementation) (Revised January 10, 2024)*
Opiate/Benzodiazepine/Muscle Relaxant Combinations (Revised February 28, 2023)*
Orilissa (Pending Implementation) (Revised March 29, 2019)*
Oxervate (Pending Implementation) (Revised January 10, 2024)*
Oxybate Products (formerly Xyrem/Xywav) (Pending Implementation) (Revised December 8, 2023)*
Oxycodone Extended-Release Agents (Revised November 9, 2023)*
Palforzia (Pending Implementation) (Revised October 19, 2022)*
PDE5-Inhibitors (Revised May 15, 2023)*
Phosphate Binders (Revised February 7, 2024)*
Plavix (Pending Implementation) (Revised March 29, 2019)*
Preferred Drug List (January 2024)*
Promethazine Utilization (Revised October 19, 2022)*
Propylthiouracil (Revised October 31, 2022)*
Proton Pump Inhibitors (Pending Implementation) (Revised March 29, 2019)*
Pulmonary Hypertension Agents (Revised January 10, 2024)*
Pulmozyme (Pending Implementation) (Revised January 24, 2022)*
Ranexa (Revised October 31, 2022)*
Recorlev (Pending Implementation) (Revised December 13, 2023)*
Recurrent Vulvovaginal Candidiasis (RVVC) Agents (Pending Implementation) (Revised December 8, 2023)*
Retinoids (Pending Implementation) (Revised July 19, 2021)*
Rezurock (Pending Implementation) (Revised October 13, 2023)*
Savella (Pending Implementation) (Revised March 29, 2019)*
SGLT2 Agents (Pending Implementation) (Revised September 12, 2023)*
SGLT2 Agents (Revised August 1, 2023)*
Sickle Cell Agents (Revised October 19, 2022)*
Skyclarys (Pending Implementation) (Revised October 13, 2023)*
Symlin (Revised December 8, 2023)*
Synagis (Revised January 11, 2024)*
Thiazolidinediones (Revised November 11, 2020)*
Topical Acne Agents (Pending Implementation) (Revised July 19, 2021)*
Topical Immunomodulators (Pending Implementation) (Revised January 26, 2024)*
Topical Immunomodulators (Revised June 24, 2020)*
Transthyretin Agents (Pending Implementation) (Revised January 10, 2024)*
Urea Cycle Disorder Agents (Pending Implementation) (Revised July 7, 2023)
Valturna (Retired) (Revised August 23, 2017)*
Veozah (Pending Implementation) (Revised August 14, 2023)*
VMAT2 Inhibitors (Pending Implementation) (Revised December 18, 2023)*
VMAT2 Inhibitors (Revised June 1, 2023)*
Voxzogo (Pending Implementation) (Revised February 20, 2024)*
Xifaxan (Revised December 8, 2023)*
Xyrem (Revised February 1, 2023)*
Zelboraf (Revised December 8, 2023)*
Ztalmy (Pending Implementation) (Revised January 20, 2023)*
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Announcements
Texas VDP Systems Change For Prescribers Begins March 2024
by TALESHIA.CORE on 01/11/2024
On Oct. 13, 2023, the Texas Health and Human Services Commission (HHSC) announced a contract award to Gainwell Technologies (Gainwell) to be the pharmacy benefits administrator for the Texas Vendor Drug Program (VDP). Beginning Saturday, March 30, 2024, Gainwell will be responsible for the following functions: Fee-for-service Medicaid and other state program pharmacy claims processing; Administration of Medicaid federal, supplemental, and value-based rebate program; Preferred drug list management; Fee-for-service Medicaid and other state program pharmacy prior authorization administration; Formulary management, including the electronic Certificate of Information (eCOI) for VDP formulary additions; Prospective and retrospective drug utilization review activities; Pharmacy, prior authorization, and technical call centers. To learn more, visit txvendordrug.com/about/news.
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.