August 01, 2022

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
CibinqoTM 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:

  1. EMR: Use PreCheck MyScript®
  2. UnitedHealthcare Provider Portal: Sign in, then go to Prior Authorizations, then select PreCheck MyScript
  3. CoverMyMeds®: Complete the online request
  4. 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.

PCA-1- 22-02196-C&S-News