Revisions of Antimigraine Agents (Triptans) Clinical Prior Authorization Criteria Scheduled for April 5 (Revised)

April 4, 2023
  • Originally published Feb. 23
  • Revised March 23*
  • Revised April 4 **

On April 5, 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:

Drug Dose Therapy Duration
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 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.

** HHSC originally scheduled this change for April 4