Clinical Prior Authorization Criteria for Calcitonin Gene-Related Peptide Receptor Antagonists Effective April 4

On April 4, 2023, the Texas Health and Human Services Commission (HHSC) will implement clinical prior authorization criteria for the treatment of calcitonin gene-related peptide receptor (CGRP) antagonists for Medicaid fee-for-service clients. The prior authorization criteria relate to Nurtec orally disintegrating tablets (ODT) and Ubrelvy, which are approved for treating acute migraines.

The CGRP antagonist (acute treatment) clinical prior authorization (PDF) is optional for MCOs. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows each MCO's prior authorizations and how these 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.