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Clinical Prior Authorization Criteria Updates for Dupixent, Evrysdi, and Qelbree

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The Texas Health and Human Services Commission (HHSC) revised the following clinical prior authorization criteria guides to reflect the recommendations from the recent U.S. Food and Drug Administration (FDA) approved indications:

  • Dupixent (Dupilumab) appears in the Monoclonal Antibody Agents clinical prior authorization criteria and is subject to non-preferred prior authorization. The updated age is 6 months or older for clients with atopic dermatitis.
  • Evrysdi (Risdiplam) is subject to clinical prior authorization The updated age will be 65 years or younger for clients.
  • Qelbree (Viloxazine) appears in the Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) Medications prior authorization criteria and is subject to non-preferred prior authorization. The limit for max units has been increased to 3 units per day for adults.

HHSC will notify providers when we plan to implement the clinical prior authorization criteria for fee-for-service.

These clinical prior authorizations are optional for managed care. The Pharmacy Clinical Prior Authorization Assistance Chart shows each managed care organization’s (MCO’s) prior authorizations 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.