On June 13, 2023, HHSC will add the following drugs and generic code numbers (GCNs) to the "Drugs Requiring Prior Authorization" table on page 2 of the Opiate/Benzodiazepine/Muscle Relaxant Combinations prior authorization clinical criteria document:
- Codeine sulfate
- GCN: 16240
- Levorphanol
- GCN: 16350
- Oxycodone-acetaminophen solution
- GCN: 70470
- Tramadol
- GCN: 92069
The therapeutic overlap that is in Step 1 of the clinical criteria logic diagram on pages 13–15 of the prior authorization clinical criteria document will change from 14 days to 10 days.
The Opiate/Benzodiazepine/Muscle Relaxant Combinations (PDF) clinical prior authorization is optional for managed care.
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.