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HHSC to Update Hereditary Angioedema Clinical Prior Authorization for Medicaid Fee-for-Service

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On May 23, 2023, the Texas Health and Human Services Commission (HHSC) will add icatibant drugs (generic code 14778) to the Medicaid fee-for-service program list of drugs that require prior authorization. This list is published in the hereditary angioedema clinical prior authorization criteria guide.

This 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 these authorizations relate to those that are used for processing fee-for-service Medicaid claims. This chart is updated quarterly. Providers can refer to the MCO Resources page for links to each MCO's list of clinical prior authorizations.

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