Provider Alert! Dupixent (dupilumab) Criteria UpdateTexas Children's Health Plan
Date: December 7, 2021
Attention: Primary Care Providers and Pulmonologists
Subject: Dupixent (dupilumab) Criteria Update
Effective Date: October 20, 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 October 20, 2021, Texas Medicaid revised criteria of the Dupixent (dupilumab). Dupixent is FDA-approved as an add-on maintenance treatment for individuals 6 years and older with moderate-to-severe eosinophilic phenotype asthma, or with oral corticosteroid dependent asthma.
How this impacts providers: The previous criteria required individuals to be 12 years and older for diagnosis of moderate to severe asthma. The revised criteria omits that step to expand treatment to individuals 6 years and older.
Next steps for providers: Providers need to use updated prior authorization forms and providers should share this update with their staff as well.
- Navitus TX Medicaid Prior Authorization Forms
If you have any questions, please email TCHP Pharmacy Department at: TCHPPharmacy@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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