February 26, 2020

VDP will implement the Growth Hormone clinical prior authorization criteria on May 28 for traditional Medicaid. The criteria (PDF) were approved by the Texas Drug Utilization Review Board at its April 2017 meeting. The implementation will include four diagnosis codes for approval as suggested by MCOs and approved by VDP:

  • Q87.11: Prader-Willi Syndrome
  • Q87.19: Noonan Syndrome
  • E34.3: SHOX deficiency with Dyschondrosteosis
  • Q78.8: SHOX deficiency with short stature

The Growth Hormone 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. The chart is updated quarterly.

Contact vdp-formulary@hhsc.state.tx.us for more information

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Clinical PA