Provider Alert! Implementation of Sotyktu Criteria in Cytokine and CAM Antagonists Clinical Prior Authorization
Date: August 4, 2023
Attention: All Providers
Effective Date: July, 27 2023
Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July, 27 2023, the Texas Health and Human Services Commission (HHSC) implemented criteria for Sotyktu®. Sotyktu® belongs to the Cytokine and CAM Antagonists class and is indicated for the treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy.
How this impacts providers: The new criteria is available on the HHSC Vendor Drug Program website and can also be viewed here: Sotyktu® Criteria in Cytokine and CAM Antagonists Clinical Prior Authorization Criteria.
Next steps for providers: Prescribers should share this communication with their staff. Provider must submit documentation (such as office chart notes, lab results, other pertinent clinical information, etc.) supporting that the member has met all appropriate criteria in support for Sotyktu® approval.
Note: If request is for a non-FDA approved dose or indication, medical rational must be submitted in support of therapy (such as high-quality peer reviewed literature, acceptable compendia or evidence based practice guidelines) and exceptions will be considered on a case-by-case basis.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
