Skip to main content

Annual Review of Clinical Prior Authorization Criteria Guides in Effect – Changes Scheduled for February 7, 2023

Last updated on

The Texas Health and Human Services Commission (HHSC) has initiated the annual internal review of clinical prior authorizations. A detailed list of revisions is available on the Vendor Drug Program website. These clinical prior authorizations are optional for managed care organizations (MCOs). MCOs that use these clinical prior authorizations must revise their criteria by February 7, 2023. The annual internal review applies to the following list of clinical prior authorizations:

  • Agents of Gaucher’s disease
  • Allergen extracts
  • Amantadine extended-release agents
  • Antimigraine agents, triptans
  • Anxiolytics and sedatives/hypnotics (ASH)
  • Bylvay (odevixibat)
  • Calcitonin gene-related peptide receptor (CGRP) (acute treatment)
  • Calcitonin gene-related peptide receptor (CGRP) (prophylaxis)
  • Carisoprodol-containing agents
  • Carisoprodol overuse
  • Central nervous system (CNS) stimulants
  • Cough and cold medications
  • Cyclobenzaprine
  • Cymbalta (duloxetine)
  • Cytokine and CAM antagonists
  • Desmopressin
  • Diclofenac
  • Dopamine agonists (Apokyn and Kynmobi)
  • Duplicate therapy
  • Enzymes
  • Erythropoiesis-stimulating agents (ESA)
  • Forteo (teriparatide)
  • Gabapentin agents
  • Gastrointestinal (GI) motility
  • Glatiramer acetate injection
  • Gonadotropin-releasing hormones (GnRH) receptor antagonists
  • Hemady (dexamethasone)
  • Hereditary angioedema (HAE)
  • P. Acthar
  • Hyperlipidemia agents (formerly PCSK9 inhibitors)
  • Imiquimod
  • INCRELEX (mecasermin)
  • Inhaled antibiotics
  • Ketorolac
  • Keveyis
  • Leukotriene modifiers
  • Lidocaine patch
  • Monoclonal antibodies for asthma
  • Opiate overutilization
  • Oxervate (cenegermin-bkbj)
  • Oxycodone extended-release agents
  • Palforzia (peanut allergen powder)
  • PDE5-inhibitors
  • Promethazine agents
  • Propylthiouracil (PTU)
  • Pulmonary hypertension (PAH)
  • Ranexa
  • Sickle cell disease agents
  • Topical immunomodulators
  • Transthyretin agents