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|