February 21, 2020
VDP will implement the Trikafta criteria within the existing Cystic Fibrosis Agents clinical prior authorization (PDF) on Feb. 24.
The Texas Drug Utilization Review Board approved the criteria for Trikafta at the Jan. 2020 meeting. Trikafta is a cystic fibrosis transmembrane conductance regulator (CFTR) modulating agent. As part of the criteria is a check for duplicative or concurrent therapies with another CFTR modulating agent. The board recommended inclusion of this step to the criteria for all CFTR modulator agents.
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.