PDL Prior Authorization Criteria Revisions Scheduled For October 11

September 22, 2022

On October 11, 2022, HHSC will revise step one of the PDL prior authorization criteria guides for the Bronchodilators, Beta Agoniststs and Glucagon Agents drug class. These changes will modify the duration of treatment with a preferred agent per the Food and Drug Administration (FDA).

  • For the Bronchodilators, Beta Agonists PDL criteria, step one will require a treatment failure after a 14-day trial with at least one preferred agent in the last 180 days. Currently, the PDL criteria require a 30-day treatment trial with at least one preferred agent.
  • For the Glucagon Agents PDL criteria, step one will require a one-day treatment trial with at least one preferred agent in the last 180 days. Currently, the PDL criteria require a 30-day treatment trial with at least one preferred agent.

These changes will also help to ensure quicker access to other effective treatment options for medications in those drug classes. The PDL prior authorization criteria are mandatory for managed care. Any changes must be implemented by the MCOs no later than October 11.