Provider Alert! TCHP Prior Authorization RequirementTexas Children's Health Plan
Subject: TCHP Prior Authorization Requirement
Effective April 1, 2018, TCHP will be updating the prior authorization listing. This notice will serve as your 90-day advance notification of the change.
Please note there are some key changes for providers.
Removed from the list and will no longer require prior authorization:
- Vision Care, medically necessary
New to the list:
- High cost injectable drugs (>$75K per dose) in an outpatient level of care require prior authorization. Examples include: Kymriah, Spinraza, Exondys
- Progesterone therapy has been updated to Hydroxyprogesterone caproate injections.
- Transplant evaluation has been updated to transplants including solid organ and bone marrow.
The new TCHP prior authorization list will also be posted at: http://www.tchp.us/for-providers/provider-resources
If there are further questions, please contact the Provider Relations Department at 1-800-731-8527
Leave a Reply