June 4, 2018
The Vendor Drug Program will implement a clinical prior authorization for Symdeko for people enrolled in traditional Medicaid. The criteria was approved by the Texas Drug Utilization Review Board during its meeting in April, and will go into effect July 16. To learn more please review the cystic fibrosis agents prior authorization criteria guide (PDF).
This prior authorization is optional for people enrolled in Medicaid managed care. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization each health plan uses and how those authorizations relate to the authorizations used for traditional Medicaid claim processing. This chart is updated quarterly. Providers can also refer to our MCO Resources for links to each health plan's clinical prior authorizations.