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Revisions of Antimigraine Agents (Triptans) Prior Authorization Clinical Criteria Scheduled for April 4, 2023

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On April 4, 2023, the Texas Health and Human Services Commission (HHSC) will revise the prior authorization clinical criteria for antimigraine agents (triptans).

This revision will add a step to check for the maximum dose per 30 days of therapy as stated in the products' package inserts for established drug safety dosing. The modifications to the criteria include the following:

Drug

Dose

Therapy Duration

Amerge

Above 20 mg

Per 30 days

Axert

Above 100 mg

Per 30 days

Frova

Above 22.5 mg

Per 30 days

Maxalt

Above 120 mg

Per 30 days

Migranal

Above 32 mg

Per 30 days

Relpax

Above 240 mg

Per 30 days

Sumatriptan

900 mg

Per 30 days

Zomig

40 mg

Per 30 days

The antimigraine agents (triptans) prior authorization clinical criteria guide is optional for managed care organizations (MCOs).

The Pharmacy Clinical Prior Authorization Assistance Chart shows each MCO's prior authorizations and how these 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 vdp-formulary@hhsc.state.tx.us with comments or questions.