Provider Alert! All MCOs: Dupixent, Evrysdi, and Qelbree Clinical Prior Authorization Criteria Updates
Date: July 13, 2022
Attention: Providers
Effective Date: August 2, 2022
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: HHSC is revising the prior authorization (PA) criteria for the following drugs: Dupixent, Evrysdi and Qelbree.
How this impacts providers: HHSC made the following revisions:
- Dupixent clinical PA criteria:
- Added diagnosis of eosinophilic esophagitis for clients ≥ 12 years of age
- Updated age to ≥ 6 months for clients with atopic dermatitis
- Evrysdi clinical PA criteria
- Updated age for Evrysdi to < 65 years
- Qelbree clinical PA criteria
- Updated age for Qelbree (recently updated by the FDA; now indicated for patients ≥ 6 years)
- Updated Qelbree maximum quantity to ≤ 3 units per for clients ≥ 18
Next steps for providers: Updated PA forms can be found on Navitus. Prescribers should share this communication with their staff.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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