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News update

Mar 28, 2025

Texas Medicaid: Updated Prior Authorization Requirements for Medications

Texas Medicaid introduced new requirements for state-mandated medication prior authorization procedures. New prior authorization requirements will begin on May 1, 2025 while specific medication clinical criteria will receive updates at that time. The new changes affect UnitedHealthcare Community Plan of Texas CHIP, STAR, STAR Kids and STAR+PLUS health plans.

Clinical Criteria Guidelines	Medication	Clinical Criteria Updates
Monoclonal Antibody Agents	Tezspire® (tezepelumab-ekko)	Criteria added for Tezspire
	Ebglyss™ (lebrikizumab-lbkz)	Criteria added for Ebglyss, approved by the Drug Utilization Review Board

So, this material should assist you in deciding whether you will have to submit a prior authorization request or instead just make a note of the clinical criteria before ordering any of these medications.

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