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Updates to Phosphate Binder Prior Authorization Criteria Scheduled for April 5, 2022

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On April 5, 2022, the Texas Health and Human Services Commission (HHSC) will revise the phosphate binder non-preferred prior authorization criteria by transferring specific criteria to the phosphate binders clinical prior authorization. This update correlates with the recent Texas Drug Utilization Review Board-approved revisions to the phosphate binder clinical prior authorization criteria. In this process, HHSC will also rearrange some of the steps to help improve the way each step flows into the next.

The changes to the non-preferred prior authorization criteria are mandatory for managed care organizations (MCOs). The phosphate binders clinical prior authorization remains optional for managed care. The Pharmacy Clinical Prior Authorization Assistance Chart indicates which prior authorization each MCO uses. The chart is updated quarterly. Providers can also refer to the MCO Resources for links to each MCO's list of clinical prior authorizations.

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