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