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February 01, 2024

Texas: Prior authorization updates for certain medications

Effective March 1, 2024, we’ll make the following changes for UnitedHealthcare Community Plan of Texas CHIP, STAR, STAR Kids and STAR+PLUS plans:

  • New prior authorization requirements for Grastek®, Ragwitek®, Mircera® and Reblozyl®
  • Updates to our clinical criteria for Zavzpret™, Tyrvaya® and Austedo®/Austedo® XR

These changes align with Texas Health and Human Services Commission criteria.

Medications Clinical criteria guidelines Clinical criteria updates
Grastek (Timothy grass pollen allergen extract)
2800 BAU sublingual tablet
Allergen Extracts New prior authorization criteria
Ragwitek (short ragweed pollen allergen extract)
Sublingual tablet
Allergen Extracts New prior authorization criteria
Zavzpret (zavegepant)
10 mg nasal spray

Calcitonin Gene-Related Peptide Receptor (CGRP) Antagonists (Acute Treatment)

  • New prior authorization criteria
  • Added check for concurrent therapy with a prophylactic agent
  • Updated check for concurrent use of contraindicated drugs
Mircera (methoxy polyethylene glycol-epoetin beta)
30, 50, 75, 100, 150 or 200 mcg in 0.3 ml syringe
Erythropoiesis-Stimulating Agents New prior authorization criteria
Reblozyl (luspatercept-aamt)
25 and 75 mg vials
Erythropoiesis-Stimulating Agents New prior authorization criteria
Tyrvaya (varenicline solution)
0.03 mg nasal spray
Immunomodulator Agents for Dry Eye New prior authorization criteria

Austedo (deutetrabenazine)
6, 9 and 12 mg tablets

Austedo XR

  • 6, 12 or 24 mg tablets
  • Titration Kit (Week 1-4)
Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors
  • Added diagnosis of tardive dyskinesia
  • Added check for dopamine blocking therapy for tardive dyskinesia diagnosis

Questions? We're here to help.

Chat with us 7 a.m.–7 p.m. CT, Monday – Friday from the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.

PCA-1-23-04204-Clinical-NN_01082024

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