January 17, 2020
VDP will modify the Austedo prior authorization criteria on March 3. The criteria are included within the existing Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors criteria guide. The Texas Drug Utilization Review Board approved the criteria in Jan. 2014. The class includes Austedo, Xenazine and Ingrezza.
Austedo is approved for treatment of Huntington-Induced Chorea and Tardive Dyskinesia (TD). VDP will modify the prior authorization criteria to address the Austedo boxed warning about increased risk of depression in patients with only Huntington-Induced Chorea, and prevent unnecessary prior authorization denials for patients with TD.
- The current criteria (PDF) denies all patients with Huntington-Induced Chorea and TD with a history of severe depression or suicide attempts/ideation in the past 180 days.
- The revised criteria (PDF) denies prior authorizations only for treatment of Huntington-Induced Chorea in patients with history of severe depression or suicide attempt/ideation in the last 180 days.
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 or comments to firstname.lastname@example.org.