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January 01, 2024

Texas: Prior authorization updates for certain medications

Affects UnitedHealthcare Community Plan of Texas STAR, STAR Kids and STAR+PLUS plans

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

  • New prior authorization requirements for Filspari™, Imcivree®, Rezurock®, Skyclarys® and Sogroya®
  • Updates to our clinical criteria for Skytrofa®

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

Medications Clinical criteria guidelines Clinical criteria updates
Filspari (sparsentan)
200 and 400 mg tablets
Filspari New prior authorization criteria
Imcivree (setmelanotide)
10 mg/ml vial
Imcivree New prior authorization criteria
Rezurock (belumosudil)
200 mg tablet
Rezurock New prior authorization criteria
Skyclarys (omaveloxolone)
50 mg capsule
Skyclarys New prior authorization criteria
Skytrofa (lonapegsomatropin-tcgd)
3, 3.6, 4.3, 5.2, 6.3, 7.6, 9.1, 11 and 13.3 mg cartridges
Growth Hormone

Added check for existing papilledema to criteria logic

Added check for obstructive sleep apnea and negating check for CPAP/BiPAP usage for clients with Prader-Willi syndrome

Sogroya (somapacitan-beco)
5 mg/1.5 ml, 10 mg/1.5 ml and 15 mg/1.5 ml pens
Growth Hormone New prior authorization criteria

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-1-23-03999-Clinical-NN_12112023

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