clinical prior authorization – Page 2

12AprApril 12, 2023

Provider Alert! Livmarli Clinical Prior Authorization Criteria Revision Scheduled for May 30, 2023

Date: April 11, 2023 Attention: All Providers Effective Date: May 30, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective May 30, 2023, the Health and Human Services Commission (HHSC) will update prior authorization criteria for Livmarli that meets the recent FDA-approved age indication. How this impacts providers: Starting May 30, 2023, TCHP will expand the age requirement to pediatric patients three months and older. Next steps for providers: Prescribers should share this communication with their staff. Provider...

By Texas Children's Health PlanFacilities, HHSC, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, Criteria, Livmarli, Revision0 CommentsRead more...

16FebFebruary 16, 2023

Provider Alert! Changes to Lovaza Clinical Prior Authorization Scheduled for March 21, 2023

Date: February 15, 2023 Attention: Providers Effective Date: March 21, 2023 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: The Texas Health and Human Services (HHS) will revise the Lovaza clinical prior authorization criteria guide to include any covered omega-3 fatty acids drugs. How this impacts providers: ● The...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, lovaza, Omega-30 CommentsRead more...

15NovNovember 15, 2022

Provider Alert! Annual Review of Clinical Prior Authorization Criteria Guides

Date: November 14, 2022 Attention: Providers Effective date: November 29, 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: Texas Children’s Health Plan (TCHP) will revise the following clinical prior authorization criteria: Epidiolex, GLP-1 Receptor Agonists, Lovaza & Vascepa by November 29, 2022. The changes will...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, criteria guides0 CommentsRead more...

28JanJanuary 28, 2022

Provider Alert! Removal of Specialist Requirement from Clinical Prior Authorization Criteria

Date: January 28, 2022 Attention: Providers Effective Date: January 3, 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: Effective January 3, 2022, HHSC removed the specialist requirement from the following clinical prior authorization criteria: CGRP Antagonist, Acute CGRP Antagonists, Chronic Emflaza Ophthalmic Immunomodulators Palforzia Transthyretin Agents VMAT2 Inhibitors Wakix Xyrem/Xywav Zelboraf How this impacts providers: Providers...

By Texas Children's Health PlanFacilities, OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, hhsc, Prior Authorization, specialist requirement0 CommentsRead more...

28JanJanuary 28, 2022

Provider Alert! Prior Authorization Criteria for Enzyme Replacement Therapy

Date: January 28, 2022 Attention: Providers Effective Date: March 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: Effective March 1, 2022, HHSC will require prior authorization for all enzyme replacement therapies for Medicaid and CHIP. Enzyme replacement therapy (ERT) is a medical treatment...

By Texas Children's Health PlanOB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialistsclinical prior authorization, Enzyme, Enzyme replacement therapy, Prior Authorization0 CommentsRead more...

29JunJune 29, 2021

Provider Alert! Nucala Clinical Prior Authorization Update

Date: June 29, 2021 Attention: Primary Care Providers and Pulmonologists Subject: Nucala Clinical Prior Authorization Update Effective Date: July 12, 2021 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: The Health and Human Services Commission (HHSC) will update the clinical prior authorization criteria for Nucala in the...

By Texas Children's Health PlanPrimary Care Providers, Provider Alert, SpecialistsAsthma, clinical prior authorization, monoclonal, provider alert, pulmonology0 CommentsRead more...

24MayMay 24, 2021

Provider Alert! Clinical Prior Authorization Updates for Enzymes

Date: May 20, 2021 Attention: Geneticists, Hematologists, and Oncologists Effective Date: June 30, 2021 Call to action: Effective June 30, 2021, the Texas Health and Human Services Commission (HHSC) will update the enzymes prior authorization criteria to reflect recent FDA-approved administration changes. This impacts the following agents: Adagen (pegademase bovine), Ceprotin (protein C concentrate), Fabrazyme (agalsidase beta), and Revcovi (elapegademase). Adagen (J2504 procedure code) has been discontinued by the manufacturer. Ceprotin 400-600 units vial is no longer available through retail pharmacy benefits. The Ceprotin 400-600 units...

By Texas Children's Health PlanProvider Alert, Specialistsclinical prior authorization, Prior Authorization, provider alert, provider alerts0 CommentsRead more...

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