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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 criteriaopen_in_new.

Medications Clinical criteria guidelines Clinical criteria updates
Filspari (sparsentan)
200 and 400 mg tablets
Filspariopen_in_new New prior authorization criteria
Imcivree (setmelanotide)
10 mg/ml vial
Imcivreeopen_in_new New prior authorization criteria
Rezurock (belumosudil)
200 mg tablet
Rezurockopen_in_new New prior authorization criteria
Skyclarys (omaveloxolone)
50 mg capsule
Skyclarysopen_in_new 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 Hormoneopen_in_new

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 Hormoneopen_in_new New prior authorization criteria

Questions? We're here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.open_in_new For additional contact information, visit our Contact us page.

PCA-1-23-03999-Clinical-NN_12112023

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