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Revision to Cosentyx Clinical Prior Authorization Criteria Scheduled for November 22, 2022

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On November 22, 2022, the Texas Health and Human Services Commission (HHSC) will revise Cosentyx in the cytokine and CAM inhibitor prior authorization to comply with the recent age indications approved by the Food and Drug Administration . The revised age criteria are for persons 2 years of age or older with psoriatic arthritis.

The cytokine and CAM antagonists clinical prior authorization is optional for managed care organizations (MCOs). The Pharmacy Clinical Prior Authorization Assistance Chart shows each 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.

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