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Texas Medicaid: Updated Prior Authorization Requirements for Medications
Mar 28, 2025

Texas Medicaid: Updated Prior Authorization Requirements for Medications

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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