August 31, 2017

The Vendor Drug Program will make the following updates to clinical prior authorizations on September 27:

  • Mydayis capsules will be added to the extended release criteria logic of the Attention Deficit Disorder (ADD) / Attention Deficit Hyperactivity Disorder (ADHD) clinical prior authorization.  Details are noted on pages 31-34 of the criteria guide (PDF).
  • The Fentanyl Agents prior authorization change will reflect drugs added to the historical drug and/or claim checks.  Details are noted in tables 2, 3, 4, and 7 of the criteria guide (PDF).
  • VDP will also add Emflaza (deflazacort) to the Texas Medicaid formulary and require clinical prior authorization for fee for service effective September 27.  The drug was reviewed and approved by the Texas Drug Utilization Review Board at its July 28 meeting.  Its criteria guide (PDF) is also available.

All three prior authorizations are optional for Medicaid managed care. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization each managed care organization uses and how those authorizations relate to the authorizations used for traditional Medicaid claim processing.  This chart is updated quarterly, and will be published again in November. Providers can also refer to the VDP MCO Resources for links to each MCO's clinical prior authorizations.