Provider Alert! Macrolides Clinical Prior Authorization Update

Provider Alert!

Provider Alert! Macrolides Clinical Prior Authorization Update

Date: February 19, 2021

Attention: Primary Care Providers

Effective Date: March 15, 2021

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan (TCHP) would like to inform network providers that beginning March 15, 2021 Texas Medicaid will change the preferred drug list (PDL) prior authorization criteria for the “Macrolides (oral)” PDL class.  The new exception will allow FDA-indicated shorter treatment duration with certain preferred products (such as azithromycin) before approval of a non-preferred option.

How this impacts providers: Currently, the PDL criteria document asks:

  • Has the client failed a 7-day treatment trial with at least one preferred agent in the last 180 days?

The revised version will change to:

  • Has the client failed a 7-day treatment trial with at least one preferred agent in the last 180 days? (Exception may apply when a preferred drug requires less than a 7-day treatment trial)

Next steps for providers: Providers should share this communication with their staff.

Resources: Preferred Drug List Criteria Exception for Macrolides Changes March 15; Texas Medicaid Pharmacy Prior Authorization and Preferred Drug List

If you have any questions, please email TCHP Pharmacy Department at: tchppharmacy@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.

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