Provider Alert! Removal of Specialist Requirements from CAD Clinical Policies and Prior Authorization Criteria
Date: July 13, 2022
Effective Date: August 1, 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: HHSC is updating the prior authorization criteria for some clinician administered drugs.
How this impacts providers: HHSC will no longer require the prescription include consultation with or be written by a disease state specialist in the prior authorization policy and will remove this specialist requirement from the following CAD clinical policies and prior authorization criteria:
- Antisense Oligonucleotide
- Inotuzumab Ozogamicin
- Moxetumomab Pasudotox-Tdfk
Next steps for providers: Providers should adjust their prescribing patterns and share this communication with their staff
If you have any questions, please email Provider Network Management at: firstname.lastname@example.org.