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

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This is an update to the article titled “Revisions of Antimigraine Agents (Triptans) Prior Authorization Clinical Criteria Scheduled for April 4, 2023,” which was published on March 3, 2023. In this update, the Texas Health and Human Services Commission (HHSC) will remove Migranal from the list of drugs that will receive the criteria modifications scheduled to implement on April 4, 2023, for Medicaid-fee-for-service clients. HHSC initially included Migranal in the following table, but it will be removed because it is a dihydroergotamine agent.

Effective April 4, 2023, the modifications to the criteria will be for the following drugs:

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

Relpax

Above 240 mg

Per 30 days

Sumatriptan

900 mg

Per 30 days

Zomig

40 mg

Per 30 days

Reminder: The revision to the prior authorization clinical criteria for antimigraine agents (triptans) 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 Antimigraine Agents (Triptans) Prior Authorization Program Clinical Criteria 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 that are used for processing fee-for-service Medicaid claims. This chart is updated quarterly.

Providers can also refer to the MCO Resources web page for links to each MCO's list of clinical prior authorizations.

Email vdp-formulary@hhsc.state.tx.us with comments or questions.