January 15, 2020

VDP will revise the Allergen Extracts clinical prior authorization criteria on Feb. 24.  This change reflects the Food and Drug Administration guidance expanding the indication for Oralair for people 5 years of age and older. The previous indication was for 10 years of age and older.  Additionally, VDP will change the contraindication diagnosis to include only severe, uncontrolled asthma diagnoses.

Oralair is part of the Allergen Extract clinical prior authorization criteria. The criteria guide (PDF) is available and includes:

  • The age expansion to 5 years of age and older; and
  • Step 6 of the criteria and associated table showing the diagnosis of severe and unstable/uncontrolled asthma.

This prior authorization is 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.

Providers can send questions about this change to vdp-formulary@hhsc.state.tx.us.

Tags: 
Clinical PA