cancer – The Checkup

29NovNovember 29, 2022

Provider Alert! Prior Authorization Criteria for Carvykti Begins December 1, 2022

Date: November 28, 2022 Attention: Providers Subject: Effective date: December 1, 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: Texas Children’s Health Plan (TCHP) will revise clinical prior authorization criteria for Carvykti (Ciltacabtagene autoleucel) effective December 1, 2022. It is a B-cell maturation antigen-directed genetically...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistscancer, Carvykti, multiple myeloma, Prior Authorization, REMS0 CommentsRead more...

13SepSeptember 13, 2022

Provider Alert! Prior Authorization Criteria to Change for Some CAR T-Cell Infusion Therapies

Date: September 13, 2022 Attention: All Providers Effective Date: September 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 providers that the Health and Human Services Commission (HHSC) will update the prior authorization criteria for...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsbreyanzi, cancer, Infusion, Infusion Therapy, lymphoma, Prior Authorization, T-Cell, yescarta0 CommentsRead more...

02JunJune 2, 2022

Provider Alert! Prior Authorization Criteria Updates for Yescarta and Tecartus

Date: June 1, 2022 Attention: All Providers Effective Date: July 1, 2022 Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 providers that the Health and Human Services Commission (HHSC) will update prior authorization criteria for Yescarta (Q2041)...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, SpecialistsALL, cancer, leukemia, lymphoma, Prior Authorization, tecartus, yescarta0 CommentsRead more...

16FebFebruary 16, 2022

Provider Alert! Gene Expression Profiling Procedure Code 81520 to Become a Benefit Effective April 1, 2022

Date: February 9, 2022 Attention: Providers Subject: Effective Date: April 1, 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: On September 11, 2020, Texas HHSC received a medical benefit request to add Prosigna®, a type of gene expression profiling, as a benefit of Texas Medicaid. Prosigna®...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsbreast cancer, cancer, expression, gene, procedure code, Prosigna0 CommentsRead more...

08DecDecember 8, 2021

Provider Alert! Yescarta Prior Authorization Criteria Update

Date: December 7, 2021 Attention: Oncologists Effective Date: November 1, 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 updated the clinical prior authorization criteria for Yescarta (procedure code Q2041) to align with the recent FDA indication expansion and guidance from the...

By Texas Children's Health PlanProvider Alert, Specialistscancer, Diagnosis Codes, lymphoma, oncology0 CommentsRead more...

01NovNovember 1, 2021

Provider Alert! Abecma available on Medicaid formulary with prior authorization requirements

Date: October 26, 2021 Attention: Oncologists Effective Date: October 1, 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: Prescribers should be aware that Abecma (procedure code C9081) will be available to members through Texas Medicaid pharmacy benefit effective October 1, 2021. Access will require meeting...

By Texas Children's Health PlanProvider Alert, Specialistscancer, medicaid, myeloma, oncology0 CommentsRead more...

01NovNovember 1, 2021

Provider Alert! Breyanzi available on Medicaid formulary with prior authorization requirements

Date: October 26, 2021 Attention: Oncologists Effective Date: October 1, 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: Prescribers should be aware that Breyanzi (procedure code Q2054) will be available to members through Texas Medicaid pharmacy benefit effective October 1, 2021. Access will require meeting...

By Texas Children's Health PlanProvider Alert, Specialistsbreyanzi, cancer, Formulary, lymphoma, oncology, Pharmacy, Prior Authorization0 CommentsRead more...

02FebFebruary 2, 2021

Provider Alert! Colorectal Cancer Screening Benefit Criteria to Change for Texas Medicaid

Attention: PCPs and Oncologists Effective Date: March 1, 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: Effective for dates of service on or after March 1, 2021, colorectal cancer screening benefit criteria will change for Texas Medicaid. Fecal occult blood tests, multi-targeted stool deoxyribonucleic...

By tcphPrimary Care Providers, Provider Alert, Specialistsbenefit, cancer, Colorectal cancer, medicaid, screening0 CommentsRead more...

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