Texas: Medicaid prior authorization changes for 2022

Effective Aug. 31, 2022, there is additional clinical criteria effective for the drugs listed below. You’re required to submit a prior authorization when prescribing these drugs for UnitedHealthcare Community Plan of Texas members.

Drug	Clinical criteria name	Clinical criteria updates	Clinical criteria
Rinvoq®	Cytokine and CAM antagonists	Updated systemic therapy list for treatment of atopic dermatitis to include oral immunomodulators and oral glucocorticoids Added Rinvoq ER 30 mg tablets (GCN 51719) and Rinvoq ER 45 mg tablet (GCN 52085) Added coverage for the diagnosis of ankylosing spondylitis Added clarification about prior therapy criteria for clients with atopic dermatitis. It should be 30 continuous days in the last 90 days, but for prior authorization renewal, 30-day prior therapy is not required	Managed Care Clinical Prior Authorization
Cibinqo^TM	Cytokine and CAM antagonists	Added clarification about prior therapy criteria for clients with atopic dermatitis. It should be 30 continuous days in the last 90 days, but for prior authorization renewal, 30-day prior therapy is not required	Managed Care Clinical Prior Authorization
Dupixent®	Monoclonal antibody agents	Updated age is 6 months or older for clients with atopic dermatitis	Managed Care Clinical Prior Authorization
Evrysdi®	Evrysdi	Updated age will be 65 years or younger for clients	Managed Care Clinical Prior Authorization
Qelbree®	ADD/ADHD	Limit for max units has been increased to 3 units per day for adults	Managed Care Clinical Prior Authorization

How to submit a prior authorization request
You have several options to submit your prior authorization request:

EMR: Use PreCheck MyScript®
UnitedHealthcare Provider Portal: Sign in, then go to Prior Authorizations, then select PreCheck MyScript
CoverMyMeds®: Complete the online request
Fax: Complete the Prescription Drug Benefits form and fax it to 866-940-7328

Questions?
Please contact your physician advocate or call UnitedHealthcare Provider Services, toll-free, at 888-887-9003, 8 a.m.–6 p.m. CT, Monday–Friday.

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