- Originally published Feb. 23
- Revised March 23*
On April 4, 2023, HHSC will revise the clinical prior authorization criteria for antimigraine agents (triptans). This revision will add a step to check for the maximum dose per 30 days of therapy as stated in the products' package inserts for established drug safety dosing. The modifications to the criteria include the following:
|Amerge||Above 20 mg||Per 30 days|
|Axert||Above 100 mg||Per 30 days|
|Frova||Above 22.5 mg||Per 30 days|
|Maxalt||Above 120 mg||Per 30 days|
|Relpax||Above 240 mg||Per 30 days|
|Sumatriptan||900 mg||Per 30 days|
|Zomig||40 mg||Per 30 days|
The antimigraine agents (triptans) clinical prior authorization criteria guide (PDF) is optional for managed care organizations (MCOs).
The Pharmacy Clinical Prior Authorization Assistance Chart 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.
* HHSC initially included Migranal in the dosing table, but we removed it because it is a dihydroergotamine agent.