Required Managed Care Clinical Prior Authorization

HHSC requires MCOs to implement specific clinical prior authorizations for clients enrolled in managed care. The information below identifies the dates MCOs implemented specific clinical prior authorizations. Clinical prior authorizations with an end date are no longer required and are now optional. Refer to the Pharmacy Clinical Prior Authorization Assistance Chart to identify whether an MCO still uses the criteria.

Clinical Prior AuthorizationRequired Start DateRequired End Date
AntipsychoticsMarch 1, 2012May 15, 2018
Hepatitis C VirusApril 8, 2015Dec. 31, 2022
Hormonal Therapy AgentsMarch 1, 2024 
Orkambi (part of Cystic Fibrosis Agents)Jan. 21, 2016March 1, 2021
Promethazine/Promethazine Containing ProductsMarch 1, 2012 
SynagisSept. 23, 2014