Drug Regimen Optimization Clinical Prior Authorization to Retire September 12

August 24, 2022

Beginning September 12, 2022, HHSC will remove the Drug Regimen Optimization (PDF) clinical prior authorization criteria for Medicaid.

MCOs that have implemented these criteria must remove them after Sept 12.  However, MCOs may choose to develop utilization management edits to optimize drug quantity limits as necessary.  Providers should contact the MCO for claim processing information.