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Clinical Criteria Requirements

Superior HealthPlan follows the Texas Vendor Drug Program requirements for clinical criteria as provided below.

The most recent PDL for each drug class below can be found on the Texas Vendor Drug Preferred Drug List. Clincal requirements for non-preferred drugs are on the right side of the table. 

  • Acne Agents, Oral
  • Acne Agents, Topical
  • Alzheimer’s Agents
  • Analgesics, Narcotic-Short Acting (non-parentral)
  • Analgesics, Narcotic-Long Acting
  • Androgenic Agents, Topical
  • Angiotensin Modulator Combinations
  • Angiotensin Modulators
  • Anti-Allergens, Oral
  • Antibiotics, Gastrointestinal
  • Antibiotics, Inhaled
  • Antibiotics, Topical
  • Antibiotics, Vaginal
  • Anticoagulants
  • Antidepressants, Other
  • Antidepressants, SSRIs
  • Antiemetic Anti-Vertigo Agents
  • Antifungals, Oral
  • Antifungals, Topical
  • Antihistamines, Minimally Sedating
  • Antihypertensives, Sympatholytics
  • Antihyperuricemics
  • Antimigraine Agents
  • Antiparasitics, Topical
  • Antiparkinsons’s Agents (Oral/Transdermal)
  • Antipsychotics
  • Antivirals, Antiherpetic Oral/Nasal
  • Antivirals, Antiherpetic Topical
  • Beta Blockers
  • Bile Salts
  • Bladder Relaxant Preparations
  • Bone Reabsorption Suppression and Related Agents
  • BPH Agent
  • Bronchodilators, Beta Agonist
  • Calcium Channel Blockers
  • Cephalosporins and Related Antibiotics
  • Colony Stimulating Factors
  • COPD Agents
  • Cough & Cold Drugs, Narcotic
  • Cough & Cold Drugs, Non-Narcotic
  • Cough & Cold Drugs (Nasal)
  • Cough & Cold Drugs (Oral Only)
  • Cytokine and CAM Agents
  • Epinephrine, Self-Injecting
  • Erythropoiesis Stimulating Proteins
  • Fluoroquinolones, Oral
  • Glucocorticoids, Inhaled
  • Glucocorticoids, Oral
  • Growth Hormone
  • Hepatitis C Agents
  • Hypoglycemics, Incretin Mimetics/Enhancers
  • Hypoglycemics, Insulin
  • Hypoglycemics, Meglitinides
  • Hypoglycemics, SGLT2
  • Hypoglycemics, TZD
  • Immunomodulators, Atopic Dermatitis
  • Immunosupressives, Oral
  • Impetigo Agents, Topical
  • Intranasal Rhinitis Agents
  • Iron Oral Agents
  • Irritable Bowel Syndrome
  • Leukotriene Modifiers
  • Lipotropics, Other
  • Lipotropics, Statins
  • Macrolides/Ketolides (Oral)
  • Neuropathic Pain
  • NSAIDS
  • Opiate Dependence Treatments
  • Opthalmic, Allergic Conjunctivitis
  • Opthalmic, Antibiotic
  • Opthalmic, Antibiotic-Steroid Combination
  • Opthalmic, Anti-Inflammatories
  • Opthalmic, Glaucoma Agents
  • Otic Antibiotics
  • Otic Anesthetics
  • PAH Agents, Oral/Inhalation
  • Pancreatic Enzymes
  • Penicillins
  • Phosphate Binders
  • Platelet Aggregation Inhibitors
  • Prenatal Vitamins
  • Proton Pump Inhibitors
  • Sedatives/Hypnotics
  • Skeletal Muscle Relaxants
  • Steroids, Topical
  • Stimulants and Related Agents
  • Tetracyclines
  • Ulcerative Colitis Agents