Provider Alert! Removal of Specialist Requirements from CAD Clinical Policies and Prior Authorization Criteria
Date: July 13, 2022
Attention: Providers
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
- Brexanolone
- Burosumab-Twas
- Crinzanizumab-Tmca
- Emapalumab-Izsg
- Esketamine
- Ibalizumab-Uiyk
- Inebilizumab-Cdon
- Inotuzumab Ozogamicin
- Luspatetcept-Aamt
- Mogamulizumab-Kpkc
- Moxetumomab Pasudotox-Tdfk
- Tagraxofuso-Erzs
- Teprotumumab-Trbw
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: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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