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HHSC Updates Some Clinical Prior Authorizations Criteria Guides

Last updated on 8/11/2023

The Texas Health and Human Services Commission (HHSC) has reviewed and updated some clinical prior authorizations criteria guides. Refer to the Vendor Drug Program website for a detailed list of updates.

Clinical Prior Authorizations Criteria Guides

The following clinical prior authorizations criteria guides were updated:

  • Anxiolytics/Sedatives/Hypnotics
  • Cytokine and CAM Antagonists
  • Multiple Sclerosis
  • Omega-3 Fatty Acids
  • Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors

These clinical prior authorizations are 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 Medicaid fee-for-service claims. This chart is updated quarterly.

Providers can use the MCO Search to find links to each MCO's list of clinical prior authorizations.

Email with comments or any questions.