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HHSC To Update Some Clinical Prior Authorization Criteria Guides

Last updated on 9/15/2023

The Texas Health and Human Services Commission (HHSC) has reviewed some clinical prior authorization criteria guides and will update them on October 31, 2023. Refer to the Vendor Drug Program website for a detailed list of updates.

Clinical Prior Authorization Criteria Guides

The following clinical prior authorization criteria guides will be updated:

  • Amyotrophic Lateral Sclerosis (ALS) Agents
  • Antipsychotics
  • Anxiolytics and Sedative/Hypnotics (ASH)
  • Cystic Fibrosis
  • Cytokine and Cell-adhesion Molecule (CAM) Antagonists
  • Dupixent
  • Fecal Microbiota Transplantation (FMT) Agents
  • Gastrointestinal (GI) Motility
  • Glucagon-like Peptide-1 (GLP-1) Receptor Agonists
  • Omega-3 Fatty Acids
  • Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors
  • Urea Cycle Disorder Agents
  • Veozah
  • 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 Vendor Drug Program’s MCO Search to find links to each MCO’s list of clinical prior authorizations.

Email with comments or any questions.