On June 10, 2022, HHSC will revise the Makena (hydroxyprogesterone caproate injection) authorization request form because the brand name Makena vial 250 milligram (mg) per milliliter (ml) is no longer eligible for Centers for Medicare and Medicaid Services (CMS) rebates. HHSC removed the generic code numbers for the brand name Makena 250 mg/ml from the Texas Medicaid Formulary and the clinical prior authorization criteria guide (PDF). This change only applies to the vial formulation of the brand name Makena and does not impact coverage for the auto-injector or generics on the Medicaid formulary.
The Makena clinical prior authorization is optional for managed care. Clinical Prior Authorization Assistance Chart identifies each managed care organization (MCO)'s prior authorizations. The chart is updated quarterly, and providers can also refer to the MCO Resources for links to each MCO's list of clinical prior authorizations.