Provider Alert! COVID-19 Drug Veklury (Remdesivir) is a covered benefit for Medicaid and CHIP clients

Date: March 3, 2022

Attention: Providers

Effective Date: January 21, 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: Beginning January 21, 2022, Veklury (J0248) is a covered benefit for Medicaid and CHIP clients when used in an outpatient setting.

How this impacts providers: On January 21, 2022, the U.S. Food and Drug Administration (FDA) expanded the use of Veklury (remdesivir lyophilized injection) for patients in the outpatient setting. Veklury will require prior authorization for the following populations:

• Patients 12 years of age and older
• Weighing at least 40 kg
• Have mild-to-moderate COVID-19
• High-risk for progression to severe COVID-19, including hospitalization or death

Additionally, the FDA authorized use of Veklury in pediatric patients under the Emergency Use Authorization for the following populations:

• Members weighing between 3.5 kg to less than 40 kg, or pediatric patients under 12 years weighing at least 3.5 kg
• Have mild-to-moderate COVID-19
• High-risk for progression to severe COVID-19, including hospitalization or death

HCPS code J0248 will be added to the next Texas NDC to HCPCS Crosswalk update in April. Thus, claims may be denied until April.

Next steps for providers: Prescribers should share this communication with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers