Provider Alert! Clinical Prior Authorization Criteria Update for Repatha (evolocumab)

Provider Alert!

Provider Alert! Clinical Prior Authorization Criteria Update for Repatha (evolocumab)

Date: December 7, 2021

Attention: Primary Care Providers

Effective Date: December 6, 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 Medicaid will update the clinical prior authorization criteria for Repatha (evolocumab) to reflect the recent FDA-approved age expansion.

How this impacts providers: Effective December 6, 2021, pediatric patients age 10 and older with heterozygous familial heprercholesterolemia (HeFH) will be eligible to receive Repatha. Previously, this product was approved for patients age 13 and older with homozygous familial hypercholesterolemia (HoFH).

Next steps for providers: Providers will need to use updated prior authorization forms and providers should share this update with their staff as well.


  1. Navitus TX Medicaid Prior Authorization Forms

If you have any questions, please email TCHP Pharmacy Department at:

For access to all provider alerts, log into: or

Share this post

Leave a Reply

Your email address will not be published. Required fields are marked *