MedicaidPrior AuthMedium impact
Texas Medicaid: New medication criteria and prior authorization updates
UnitedHealthcare·TX · Endocrinology, Dermatology·State news
Effective date
Sep 1, 2025
We identified it
Jan 12, 2026
Summary
Texas Medicaid is implementing new prior authorization requirements for Yorvipath® and adding clinical criteria checks for Zoryve® for plaque psoriasis treatment. These changes affect UnitedHealthcare Community Plan of Texas CHIP, STAR, STAR Kids and STAR+PLUS plans.
Action Required
By September 1, 2025: Billing team must update prior authorization workflows to obtain approval before prescribing Yorvipath®. Update clinical documentation requirements for Zoryve® to include plaque psoriasis verification. Review linked prior authorization requirements and clinical criteria documents. Claims without proper authorization will be denied.