Required Managed Care Clinical Prior Authorization

HHSC requires MCOs to implement specific clinical prior authorizations for clients enrolled in managed care. The information below identifies the dates MCOs implemented specific clinical prior authorizations. Clinical prior authorizations with an end date are no longer required and are now optional. Refer to the Pharmacy Clinical Prior Authorization Assistance Chart to identify whether an MCO still uses the criteria.

Clinical Prior Authorization Required Start Date Required End Date
Antipsychotics March 1, 2012 May 15, 2018
Hepatitis C Virus April 8, 2015  
Orkambi (part of Cystic Fibrosis Agents) January 21, 2016 March 1, 2021
Promethazine/Promethazine Containing Products March 1, 2012  
Synagis September 23, 2014