August 15, 2018
The Vendor Drug Program revised the clinical prior authorization criteria guide (PDF) for the Vascular Monoamine Transporter 2 Inhibitors. The change is to the step #2 of the criteria logic. The drugs Austedo and Xenazine can now be prescribed by a neurologist or a psychiatrist. The prior version of the criteria only allowed an approval when the drugs were prescribed by a neurologist. As a reminder, these drugs carry a black box warning regarding increased risk of depression and suicidal thoughts and behaviors.
VDP will implement this change for traditional Medicaid on Sept. 24.
This prior authorization remains optional for Medicaid managed care. Health plans that implemented this prior authorization must also revise step #2 of the criteria. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization each health plans 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 the MCO Resources for links to each health plans' clinical prior authorizations.