Provider Alert! Revision to Makena Authorization Request Form 1345 Scheduled for June 10
Date: June 3, 2022
Attention: OB-GYN Providers
Effective Date: June 10, 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: On June 10, 2022, Health and Human Services Commission (HHSC) will revise the Makena (hydroxyprogesterone caproate injection) authorization request form because the brand name Makena 250 mg/ml is no longer eligible for Centers for Medicare and Medicaid Services rebates.
How this impacts providers: HHSC removed the brand name Makena 250 mg/ml from the Texas Medicaid Formulary and the clinical prior authorization criteria guide. For patients requiring the 250mg dosing, the generic hydroxyprogesterone 250 mg/ml vial remains covered on Texas Medicaid Formulary with prior authorization criteria. Prior authorization criteria remains the same.
| Drugs Requiring Prior Authorization |
| HYDROXYPROGEST 1250 MG/5 ML |
| HYDROXYPROGEST 250 MG/ML VIAL |
| MAKENA 275 MG/1.1 ML AUTOINCT |
Next steps for providers: Prescribers should adjust their prescribing patterns accordingly and communicate these changes to their staff.
Resource: https://paxpress.txpa.hidinc.com/makena.pdf
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
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