January 15, 2020

VDP will implement the Rinvoq (upadacitinib) clinical prior authorization criteria on March 3. The criteria are included within the existing Cytokine and CAM Antagonists criteria guide (PDF).

Rinvoq is a Janus Kinase inhibitor for treatment of adults with moderate-to-severe active rheumatoid arthritis who have not responded adequately, or are intolerant, to methotrexate. The DUR Board approved the criteria at the Oct. 2019 meeting.

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.

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Clinical PA