Provider Alert! Drug Regimen Optimization Edit Removed After September 12
Date: September 20, 2022
Attention: All Providers
Effective Date: September 12, 2022
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 September 12, 2022, Texas Children’s Health Plan (TCHP) will remove the Drug Regimen Optimization prior authorization for all drugs except ADHD drugs. The Health and Human Services Commission (HHSC) established the Drug Regimen Optimization clinical prior authorization to optimize the quantity dispensed by the pharmacy based on the drug’s available strengths and cost.
How this impacts providers: TCHP will keep quantity limit of less than 2 capsules/tablets per day for ADHD ER medications. For a complete list of ADHD ER medications, please visit Navitus ADD/ADHD ER formulations prior authorization form. Please note that there are no quantity limits for members less than 18 years old.
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:
http://www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
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