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TX PA Daybue Clin Edit Criteriav1

WEBTitle: TX_PA_Daybue_Clin_Edit_Criteriav1 Author: Health Information Designs, LLC Created Date: 7/28/2023 8:34:02 AM

Actived: 3 days ago

URL: https://paxpress.txpa.hidinc.com/daybue.pdf

TX PA Xifaxan Clin Edit Criteriav8

WEBTexas Prior Authorization Program Clinical Criteria Xifaxan (Rifaximin) December 8, 2023 Copyright © 2023 Health Information Designs, LLC 13

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TX PA InhAbx Criteria Guidev5

WEBTexas Prior Authorization Program Clinical Criteria Inhaled Antibiotics . October 31, 2023 Copyright © 2023 Health Information Designs, LLC 6

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Texas Prior Authorization Program Clinical Criteria

WEBTexas Prior Authorization Program Clinical Criteria Drug/Drug Class Multiple Sclerosis (MS) Agents This criteria was recommended for review by an MCO to ensure appropriate and …

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Texas Prior Authorization Program Clinical Criteria

WEBTexas Prior Authorization Program Clinical Criteria Drug/Drug Class Ranexa Clinical Criteria Information Included in this Document Drugs requiring prior authorization: the list of …

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SGLT2 Inhibitor Agents

WEBTexas Prior Authorization Program Clinical Criteria SGLT2 Inhibitor Agents . August 1, 2023 Copyright © 2023 Health Information Designs, LLC 8

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TX HHSC PDL Criteria Guide 012624 EXTERNALv4

WEBCriteria Guide Document Overview . PDL Criteria January 25, 2024 Copyright © 2024 Health Information Designs, LLC 1 . Document Overview . Purpose

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TX PA Opiate Clin Edit CriteriaV17

WEBTexas Prior Authorization Program Clinical Criteria Opiate Overutilization

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TX PA Veozah Clin Edit Criteriav2

WEBTexas Prior Authorization Program Clinical Criteria Veozah (Fezolinetant) August 14, 2023 Copyright © 2023 Health Information Designs, LLC 6

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TX PA Nuedexta Clin Edit Criteriav4

WEBTitle: TX_PA_Nuedexta_Clin_Edit_Criteriav4 Author: Health Information Designs, Inc. Created Date: 2/14/2024 8:39:11 AM

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Home [paxpress.txpa.hidinc.com]

WEBFor assistance with Fee For Service PA requests only, call the Prior Authorization Call Center at 1-877-PA-TEXAS (1-877-728-3927)

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Antiviral Agents for Hepatitis C Virus Initial Authorization …

WEBForm 1335 Page 2 / 09-2021-E Part II. Prescriber Certification of Patient Education for Hepatitis C Treatment Please read Part I (Prior Authorization Criteria and Policy) prior to …

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Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

WEBGlucagon-Like Peptide-1 (GLP-1) Receptor Agonists authorization

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Calcitonin Gene-Related Peptide Receptor (CGRP) Antagonists …

WEBTexas Prior Authorization Program Clinical Criteria Drug/Drug Class Calcitonin Gene-Related Peptide Receptor (CGRP) Antagonists (Acute Treatment)

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Form 1342, Antiviral Agents for Hepatitis C Virus Initial …

WEBForm 1342 Page 2 / 11-2022-E Part II. Prescriber Certification of Patient Education for Hepatitis C Treatment Instructions: please read Part I (Prior Authorization Criteria and …

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Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors

WEBTexas Prior Authorization Program Clinical Criteria VMAT2 Inhibitors . February 23, 2024 Copyright © 2024 Health Information Designs, LLC 7

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Diclofenac 3% Gel, Diclofenac 1.5% and 2% Topical Solution

WEBTexas Prior Authorization Program Clinical Criteria Diclofenac 3% Topical Gel . February 20, 2024 Copyright © 2024 Health Information Designs, LLC 6

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