Clinical Prior Authorization Criteria Revisions for Bylvay Scheduled for November 21

October 28, 2022

HHSC will modify the prior authorization criteria for Bylvay in the Cholestatic Pruritis Agents clinical prior authorization criteria guide for clarification purposes to ensure the criteria approve patients with the appropriate diagnosis and comply with Food and Drug Administration-approved indications.

The modification includes rewording of Question 2:

From:  “Does the client have a diagnosis of progressive familial intrahepatic cholestasis (PFIC) confirmed with genetic testing? [Manual]”

To:  “Does the client have a diagnosis of PFIC type 2 with ABCB11 variants resulting in the non-functional or complete absence of bile salt export pump protein (BSEP-3)?”

The Cholestatic Pruritis Agents clinical prior authorization is optional for managed care organizations (MCOs). The Pharmacy Clinical Prior Authorization Assistance Chart shows each MCO's prior authorizations and how those authorizations relate to those used for processing fee-for-service Medicaid claims. This chart is updated quarterly. Providers can also refer to the MCO Resources for links to each MCO's list of clinical prior authorizations.