Provider Alert! TCHP Prior Authorization Requirement

Provider Alert! TCHP Prior Authorization Requirement

Subject: TCHP Prior Authorization Requirement

Effective April 1, 2018, TCHP will be updating the prior authorization listing. This notice will serve as your 90-day advance notification of the change.

Please note there are some key changes for providers.

Removed from the list and will no longer require prior authorization:

  • Walkers
  • Vision Care, medically necessary

New to the list:

  • High cost injectable drugs (>$75K per dose) in an outpatient level of care require prior authorization. Examples include: Kymriah, Spinraza, Exondys

Updates:

  • Progesterone therapy has been updated to Hydroxyprogesterone caproate injections.
  • Transplant evaluation has been updated to transplants including solid organ and bone marrow.

The new TCHP prior authorization list will also be posted at: http://www.tchp.us/for-providers/provider-resources

If there are further questions, please contact the Provider Relations Department at 1-800-731-8527

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