Texas Medicaid: New drug prior authorizations
Last modified: Sept. 12, 2023
Update: Change to requirement dates for prior authorization requests
Beginning in September and October, you’re required to submit prior authorization requests for the 4 medications in the table below for various Medicaid plans. If we don’t receive a prior authorization request before the date of service, we’ll deny the claim and you won’t be able to balance bill members.
These additions are based on the updated Health and Human Services Commission Texas Medicaid Preferred Drug List (PDL) and Prior Authorization (PA) Criteria.
| Prior authorizations required for STAR, STAR Kids and STAR+PLUS members | |||
|---|---|---|---|
| Medications | Clinical criteria guidelines | Clinical criteria updates | Prior authorization effective date |
| Aubagio® (teriflunomide) 14 mg tablet Aubagio® (teriflunomide) 7 mg tablet |
Multiple Sclerosis (MS) Agents | Added a new medication with 2 dose options to the Drugs Requiring Prior Authorization table. | Sept. 17, 2023 |
Austedo® XR (Deutetrabenazine) Austedo® XR (Deutetrabenazine) Austedo® XR (Deutetrabenazine) |
Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors | Added a new medication with 3 dose options to the Drugs Requiring Prior Authorization table. | Sept. 17, 2023 |
| Gattex® 5 mg 30-vial kit |
Gattex (teduglutide) | New prior authorization requirement. | Sept. 17, 2023 |
| Vascepa® (icosapent ethyl) 1 gram capsule Vascepa® (icosapent ethyl) 500 mg capsule |
Omega-3 Fatty Acids | Added a new medication with 2 dose options to the Drugs Requiring Prior Authorization table. | Sept. 17, 2023 |
| Prior authorizations required for CHIP members | |||
|---|---|---|---|
| Medications | Clinical criteria guidelines | Clinical criteria updates | Prior authorization effective date |
| Gattex® 5 mg 30-vial kit |
Gattex (teduglutide) | New prior authorization requirement. | Oct. 15, 2023 |
How to submit a prior authorization
You can submit a prior authorization request through the UnitedHealthcare Provider Portal:
- Go to UHCprovider.com and select Sign In at the top-right corner
- Sign in to the portal using your One Healthcare ID and password
- If you’re a new user and don’t have a One Healthcare ID, visit UHCprovider.com/access to get started
- In the menu, select Prior Authorizations
- In the Prior Authorization and Notification tool, scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
- Enter the required information and submit
For training, view our Prior Authorization and Notification: Interactive User Guide.
Questions?
Chat with a live advocate 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal Contact Us page. You can also contact UnitedHealthcare Provider Services at 877-842-3210, TTY/RTT 711, 7 a.m.–5 p.m. CT, Monday–Friday.
