Preferred Drug List Criteria Exception for Macrolides Changes March 15

Published on
January 29, 2021

On March 15, 2021, HHSC will change the Preferred Drug List prior authorization criteria for the “Macrolides (oral)” PDL class. The new exception will allow the Food and Drug Administration-indicated shorter treatment duration for certain preferred products (such as azithromycin) before approval of a non-preferred option.

  • Currently, the PDL criteria asks:
    • Has the client failed a 7-day treatment trial with at least one preferred agent in the last 180 days?
  • The revised version will change to:
    • Has the client failed a 7-day treatment trial with at least one preferred agent in the last 180 days? (Exception may apply when a preferred drug requires less than a 7-day treatment trial)

MCOs are required to comply with this PDL prior authorization criteria, including duration. MCOs must make similar revisions by March 15.

HHSC will publish an update to the PDL Criteria Guide (PDF) reflecting the change on March 15.