June 18, 2019

VDP will revise the Makena clinical prior authorization criteria on August 1. This includes adding:

  • ICD-10 codes for a history of spontaneous singleton preterm birth
  • The 275 mg subcutaneous formulation

The revised Makena Authorization Request (HHSC Form 1345) is available. 

This prior authorization remains optional for Medicaid managed care. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization each MCO 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 MCO's list of clinical prior authorizations.