August 01, 2024
Texas Medicaid: State-required prior authorization updates for medications
Effective Sept. 1, 2024, we’re making the following changes for UnitedHealthcare Community Plan of Texas CHIP, STAR, STAR Kids and STAR+PLUS plans:
- Adding new prior authorization requirements for appetite suppressant agents and sphingosine 1-phosphate (S1P) receptor modulators
- Updating our clinical criteria for VMAT-2 Inhibitors
These changes are based on the updated Health and Human Services Commission: Texas Medicaid Preferred Drug List (PDL) and Prior Authorization (PA) Criteria in the Texas Preferred Drug List report. Please use this information to determine if you must submit a prior authorization request or make note of the clinical criteria before prescribing these medications.
| Medications | Clinical criteria guidelines | Clinical criteria updates |
|---|---|---|
| ADIPEX-P™ (phentermine) 37.5 mg tablet |
Appetite Suppressant Agents | New prior authorization requirement |
| Lomaira™ (phentermine hydrochloride USP) 8 mg tablet |
New prior authorization requirement | |
| Phendimetrazine 35 mg tablet |
New prior authorization requirement | |
| Phentermine 15 mg or 30 mg capsule 15 mg or 30 mg capsule SA 37.5 mg capsule 37.5 mg tablet |
New prior authorization requirement | |
| VELSIPITY™ (etrasimod) 2 mg tablet |
Sphingosine 1-phosphate (S1P) Receptor Modulators | New prior authorization requirement |
| Ingrezza™ (valbenazine) 40 mg, 60 mg or 80 mg capsules 40 mg, 60 mg or 80 mg sprinkle capInitiation pack Initiation pack |
Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors |
|
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PCA-1-24-02059-Clinical-NN_07152024
