Provider Alert! Removal of Specialist Requirement from Clinical Prior Authorization Criteria
Date: January 28, 2022
Attention: Providers
Effective Date: January 3, 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: Effective January 3, 2022, HHSC removed the specialist requirement from the following clinical prior authorization criteria:
- CGRP Antagonist, Acute
- CGRP Antagonists, Chronic
- Emflaza
- Ophthalmic Immunomodulators
- Palforzia
- Transthyretin Agents
- VMAT2 Inhibitors
- Wakix
- Xyrem/Xywav
- Zelboraf
How this impacts providers: Providers will need to use updated prior authorization forms and communicate these changes to their staff.
Resources:
Navitus TX Medicaid Prior Authorization Forms
If you have any questions, please email TCHP PharmacyDepartment 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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