Provider News

Allergen Extract Clinical Prior Authorization Revision Coming February 24

FirstCare will revise the Allergen Extracts clinical prior authorization criteria on February 24, 2020. This change reflects the Food and Drug Administration guidance expanding the indication for Oralair for people 5 years of age and older. The previous indication was for 10 years of age and older. Additionally, FirstCare will change the contraindication diagnosis to include only severe, uncontrolled asthma diagnoses.

Oralair is part of the Allergen Extract clinical prior authorization criteria. All clinical edit criteria can be found here.

Austedo Clinical Prior Authorization Criteria Revision Coming March 3

FirstCare will modify the Austedo prior authorization criteria on March 3, 2020. The criteria are included within the existing Vesicular Monoamine Transporter 2 (VMAT2) inhibitors criteria guide. All clinical edit criteria can be found here. The Texas Drug Utilization Review Board approved the criteria in January 2014. The class includes Austedo, Xenazine and Ingrezza.

Austedo is approved for treatment of Huntington-Induced Chorea and Tardive Dyskinesia (TD). FirstCare will modify the prior authorization criteria to address the Austedo boxed warning about increased risk of depression in patients with only Huntington-Induced Chorea, and prevent unnecessary prior authorization denials for patients with TD.

Rinvoq Clinical Prior Authorization begins March 3

FirstCare will implement the Rinvoq (upadacitinib) clinical prior authorization criteria on March 3, 2020. All clinical edit criteria can be found here. New Rinvoq criteria will be included within the existing Cytokine and CAM Antagonists criteria guide.

Rinvoq is a Janus Kinase inhibitor for treatment of adults with moderate-to-severe active rheumatoid arthritis who have not responded adequately, or are intolerant, to methotrexate. The Texas DUR Board approved the criteria at the Oct. 2019 meeting.