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Revision to Makena Authorization Request Form Scheduled for June 10, 2022

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On June 10, 2022, the Texas Health and Human Services Commission (HHSC) will revise the Makena (hydroxyprogesterone caproate injection) authorization request form because the brand name Makena 250 milligrams (mg) per milliliter (mL) is no longer eligible for Centers for Medicare and Medicaid Services (CMS) rebates. HHSC will remove the generic code numbers (GCNs) for the brand name Makena 250 mg/mL from the Texas Medicaid Formulary and the clinical prior authorization criteria guide.

The Makena clinical prior authorization is optional for managed care. The Pharmacy Clinical Prior Authorization Assistance Chart identifies each managed care organization’s (MCO’s) prior authorizations. The chart is updated quarterly, and providers can also refer to the MCO Resources for links to each MCO's list of clinical prior authorizations.

Contact vdp-formulary@hhsc.state.tx.us with comments or any questions.