Provider Alert! PDL Prior Authorization Criteria Revisions Scheduled for October 11

Date: October 11, 2022

Attention: All Providers

Effective Date: October 11, 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: Effective October 11, 2022, Texas Children’s Health Plan (TCHP) will revise the preferred drug list (PDL) prior authorization criteria guide for the Bronchodilators, Beta Agonists, and Glucagon Agents drug classes. These changes will modify the duration of treatment with a preferred agent in each of these drug classes.

How this impacts providers: Currently, the PDL criteria requires a 30-day treatment trial with at least 1 preferred agent. Beginning October 11, 2022, TCHP will revise step one of the PDL prior authorization criteria to require a 14-day treatment trial with a preferred agent for the Bronchodilators, Beta Agonists, and a one-day treatment trial with a preferred agent for the Glucagon Agents

• For the Bronchodilators, Beta Agonists PDL criteria, step one will require a treatment failure after a 14-day trial with at least one preferred agent in the last 180 days. Some preferred agents include Proventil HFA, Ventolin HFA, Albuterol nebulizer.
• For the Glucagon Agents PDL criteria, step one will require a one-day treatment trial with at least one preferred agent in the last 180 days. Some preferred agents include Baqsimi, Glucagon injection, Glucagon emergency kit, Gvoke syringe, Proglycem and Zegalogue.

Next steps for providers: PDL prior authorization criteria can be found on the Navitus page. Providers 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