Update to "HHSC To Implement Clinical Prior Authorizations For Fee-For-Service"

HHSC originally published this article March 23, 2023. The original implementation date was May 2, 2023.

On May 23, 2023, HHSC will implement the following clinical prior authorizations for clients enrolled in Medicaid fee-for-service:

• Sodium-glucose linked transporter-2 (SGLT-2) Agents (PDF)
• Juxtapid criteria
  • Part of the Hyperlipidemia Agents (PDF) clinical prior authorization
• Zelboraf (PDF)

These prior authorizations are optional for MCOs.

The Pharmacy Clinical Prior Authorization Assistance Chart shows each MCO's prior authorizations and how these authorizations relate to those that are used for processing fee-for-service Medicaid claims. This chart is updated quarterly. Providers can refer to the MCO Resources page for links to each MCO’s list of clinical prior authorizations.