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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 txvendordrug.com/about/news.
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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 txvendordrug.com/about/news.
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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 txvendordrug.com/about/news.
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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 txvendordrug.com/about/news. |
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 txvendordrug.com/about/news. |
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 txvendordrug.com/about/news. |
Annual Review of Clinical Prior Authorization Criteria Guides to Begin; Changes Scheduled for February 7
by TALESHIA.CORE on 12/28/2022
HHSC initiated an annual internal review of specific clinical prior authorizations. A detailed list of revisions is available on the Vendor Drug Program website. All of these clinical prior authorizations are optional for MCOs. MCOs using these clinical prior authorizations must revise their criteria by February 7, 2023.
To learn more, visit txvendordrug.com/about/news. |
Clinical Prior Authorization Criteria Revisions for Bylvay Scheduled for November 21
by TALESHIA.CORE on 10/28/2022
HHSC will modify the prior authorization criteria for Bylvay in the Cholestatic Pruritis Agents clinical prior authorization criteria guide for clarification purposes to ensure the criteria approve patients with the appropriate diagnosis and comply with Food and Drug Administration-approved age indications. The Cholestatic Pruritis Agents clinical prior authorization is optional for MCOs.
To learn more, visit txvendordrug.com/about/news. |
Clinical Criteria Update for Orkambi Scheduled For November 9
by TALESHIA.CORE on 10/07/2022
On November 9, 2022, HHSC will implement the clinical prior authorization criteria updates for Orkambi (lumacaftor/ivacaftor). This change follows the U.S. Food and Drug Administration's (FDA) recent approval for age expansion. The Cystic Fibrosis Agents clinical prior authorization is optional for MCOs.
To learn more, visit txvendordrug.com/about/news. |
PDL Prior Authorization Criteria Revisions Scheduled For October 11
by TALESHIA.CORE on 09/22/2022
On October 11, 2022, HHSC will revise step one of the PDL prior authorization criteria guides for the Bronchodilators, Beta Agoniststs and Glucagon Agents drug class. These changes will modify the duration of treatment with a preferred agent per the Food and Drug Administration (FDA). The PDL prior authorization criteria are mandatory for managed care. Any changes must be implemented by the MCOs no later than October 11.
To learn more, visit txvendordrug.com/about/news. |
Hepatitis C Treatment Coverage and PDL Update Scheduled for 2023
by TALESHIA.CORE on 09/06/2022
On January 1, 2023, HHSC 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. HHSC originally announced these changes would occur on September 1, 2022.
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) 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. |