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You are on the Medicaid VENDOR DRUG-DUR page

Texas Medicaid/CHIP

Drug Utilization Review


CRITERIA FOR OUTPATIENT USE
  1. Acetylcholinesterase Inhibitors
  2. Aerosolized Agents - Metered-Dose Inhalers: Anticholinergic Drugs
  3. Aerosolized Agents (Metered-Dose Inhalers) – Inhaled anti-inflammatory drugs: Corticosteroids
  4. Aerosolized Agents - Metered-Dose Inhalers: Beta2-Adrenergic Drugs (long-acting)
  5. Aerosolized Agents - Metered-Dose Inhalers:Beta2-Adrenergic Drugs (short-acting)
  6. Angiotensin-Converting Enzyme (ACE) Inhibitors 
  7. Angiotensin II Receptor Antagonists - Losartan (Cozaar® )  
  8. Antidepressant Drugs 
  9. Antidiabetic Agents, Oral  
  10. Antihistamines, Nonsedating
  11. Aprepitant (Emend® )
  12. Attention Deficit Disorder (ADD)/ Attention Deficit Hyperactivity Disorder (ADHD) Medications
  13. Atypical Antipsychotics  
  14. Benzodiazepines  
  15. Cyclooxygenase-2 (COX-2) Inhibitors  
  16. Exenatide (Byetta®) 
  17. Fentanyl Transmucosal Lozenges and Buccal Tablets 
  18. Fluoroquinolones 
  19. Dolasetron (Anzemet®), Granisetron (Kytril®), Ondansetron (Zofran®) - 5-Hydroxytryptamine Subtype 3 (5-HT3 ) Receptor Antagonists  
  20. Gabapentin (Neurontin®)
  21. Histamine H2 - Receptor Antagonists  
  22. HMG-CoA Reductase Inhibitors
  23. Hydrocodone Bitartrate
  24. Ketorolac (Toradol® ), Oral 
  25. Leukotriene Receptor Antagonists 
  26. Low-Dose Quetiapine  
  27. Low Molecular- Weight Heparins(LMWH) 
  28. Mecasermin
  29. Memantine (Namenda®)
  30. Nebulized Bronchodilators
  31. Nitazoxanide
  32. Non-Steroidal Anti-Inflammatory Drugs
  33. Pramlintide (Symlin®)
  34. Promethazine Use In Children < 2 Years of Age
  35. Proton Pump Inhibitors
  36. Rifaximin (Xifaxan®)
  37. Sedative/Hypnotics
  38. Serotonin 5-HT1B/1D Receptor Agonists 
  39. Skeletal Muscle Relaxants
  40. Sucralfate (Carafate®)
  41. Topical Calcineurin Inhibitors: Elidel®, Protopic®
  42. Tramadol (Ultram® )
Important Disclaimer: The information contained at this site and available for download is for the convenience of the public. Some documents are made available in specific file formats to respond to specific requests. The Health and Human Services Commission is not responsible for any errors in transmission or any errors or omissions in the documents.
This page is maintained by the HHSC Medicaid/CHIP: Vendor Drug Program. Comments and suggestions may be addressed to: contact@hhsc.state.tx.us
Last Update: 6/2010.

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