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HHSC to Update Nucala Clinical Prior Authorization Criteria July 12, 2021

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Effective July 12, 2021, the Texas Health and Human Services Commission will revise the Nucala clinical prior authorization criteria of the Monoclonal Antibody Agents for Asthma Clinical Criteria Guide in accordance with indications approved by the U.S. Food and Drug Administration. 

Nucala is indicated as maintenance therapy for Medicaid clients with severe eosinophilic asthma who are age 6 and older.

Note: The autoinjector and prefilled syringe products are only FDA-approved for at-home use for Medicaid clients ages 12 and older.

The Monoclonal Antibody Agents for Asthma clinical prior authorization is optional for Medicaid Managed Care (MCOs). The Pharmacy Clinical Prior Authorization Assistance Chart details the prior authorization each MCO uses and how those authorizations relate to those used for processing fee-for-service Medicaid claims. This chart is updated quarterly.

Providers can also refer to the MCO Resources for links to each MCO’s list of clinical prior authorizations.

Email questions or comments to VDP-Formulary@hhsc.state.tx.us.