January 01, 2024
Texas: Prior authorization updates for certain medications
Affects UnitedHealthcare Community Plan of Texas STAR, STAR Kids and STAR+PLUS plans
Effective Feb. 1, 2024, we’ll make the following changes for UnitedHealthcare Community Plan of Texas STAR, STAR Kids and STAR+PLUS plans:
- New prior authorization requirements for Filspari™, Imcivree®, Rezurock®, Skyclarys® and Sogroya®
- Updates to our clinical criteria for Skytrofa®
These changes align with new Texas Health and Human Services Commission criteria.
| Medications | Clinical criteria guidelines | Clinical criteria updates |
|---|---|---|
| Filspari (sparsentan) 200 and 400 mg tablets |
Filspari | New prior authorization criteria |
| Imcivree (setmelanotide) 10 mg/ml vial |
Imcivree | New prior authorization criteria |
| Rezurock (belumosudil) 200 mg tablet |
Rezurock | New prior authorization criteria |
| Skyclarys (omaveloxolone) 50 mg capsule |
Skyclarys | New prior authorization criteria |
| Skytrofa (lonapegsomatropin-tcgd) 3, 3.6, 4.3, 5.2, 6.3, 7.6, 9.1, 11 and 13.3 mg cartridges |
Growth Hormone | Added check for existing papilledema to criteria logic Added check for obstructive sleep apnea and negating check for CPAP/BiPAP usage for clients with Prader-Willi syndrome |
| Sogroya (somapacitan-beco) 5 mg/1.5 ml, 10 mg/1.5 ml and 15 mg/1.5 ml pens |
Growth Hormone | New prior authorization criteria |
Questions? We're here to help.
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PCA-1-23-03999-Clinical-NN_12112023
