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Clinical Criteria Requirements

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

View the most recent PDL for each drug class below here: Preferred Drug List as of 7/27/18 (PDF)

  • 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