April 01, 2022

Texas Medicaid: Prior authorization changes starting May 2022

Effective May 1, 2022, prior authorization is required when prescribing drugs for UnitedHealthcare Community Plan of Texas members to treat the following conditions:

  • Neuromyelitis optica spectrum disorder (NMOSD)
  • Eczema
  • Migraine prevention

The following drugs will require prior authorization:

Drug Clinical criteria name Clinical criteria
EnspryngTM 120mg/mL prefilled syringe solution for injection

Cytokine and CAM antagonists

Managed care clinical prior authorization

OpzeluraTM 1.5% topical cream

Topical immunomodulators

Managed care clinical prior authorization

QULIPTATM 10mg tablet

Calcitonin gene-related peptide receptor (CGRP) antagonists, prophylaxis

Managed care clinical prior authorization

QULIPTA 30mg tablet
QULIPTA 60mg tablet

How to request prior authorization

You have several options to submit your prior authorization request:

  • EMR: Use PreCheck MyScript®
  • UnitedHealthcare Provider Portal:
    • Visit and select Sign In in the upper-right corner
    • Sign in to the portal with your One Healthcare ID and password
    • 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

Contact your physician advocate or call Provider Services at 888-887-9003, 8 a.m.­­­­–6 p.m. CT, Monday–Friday.