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Criteria Updates to Opiate/Benzodiazepine/Muscle Relaxant Combinations Clinical Prior Authorization Effective February 27, 2024

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On February 27, 2024, the Texas Health and Human Services Commission (HHSC) will implement updates to clinical prior authorization for Opiate/Benzodiazepine/Muscle Relaxant Combinations clinical prior authorization. These updates will apply to fee-for-service Medicaid.

The updates include the reduction of therapeutic overlaps from greater than or equal to 10 days to greater than or equal to 7 days with any of the following combinations: 

  • Opiates, benzodiazepines, and muscle relaxants
  • Opiates and benzodiazepines
  • Benzodiazepines and muscle relaxants

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