| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Selective Dorsal Rhizotomy (CP.MP.174) (RETIRED - Medicaid January 17, 2024) | |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Casirivimab and imdevimab (REGN-COV2) (RETIRED Medicaid and Ambetter June 1, 2023) (CP.PHAR.520) | |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Bamlanivimab-etesevimab (LY-CoV555-LY-CoV016) (CP.PHAR.532) (RETIRED Medicaid and Ambetter June 1, 2023) | |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Incontinence Supplies (TX.CP.MP.508) (RETIRED Medicaid June 1, 2023) | |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Radiofrequency ablation of uterine fibroids | |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Makena Clinical Criteria for Authorization via Medical Benefit (TX.PHAR.15) - RETIRED (Medicaid April 10, 2022) | |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Netarsudil (Rhopressa), Netarsudil/Latanoprost (Rocklatan) (CP.PMN.118)- RETIRED (Ambetter March 1, 2023) | |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Nebivolol (Bystolic) (HIM.PA.131) - RETIRED (Ambetter June 1, 2022) | |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Natalizumab (Tysabri) (HIM.PA.SP17) - RETIRED (Ambetter June 1, 2022) | |
| Ambetter Health Texas Wellcare Allwell Medicare Clinical | Lorcaserin (Belviq, Belviq XR) (CP.PCH.03) - RETIRED (Ambetter June 1, 2022) | |