Tag - Pharmacy
05Dec

Provider Alert! Coverage of Commercialized COVID-19 Vaccines Begins as a Pharmacy Benefit

Effective Dates: As of September 11, 2023 & October 3, 2023 Date: December 4, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 11, 2023 and October 3, 2023, the U.S. Food and Drug Administration’s (FDA) issued approval and Emergency Use Authorization (EUA) for the following COVID-19 vaccines: As of September 11, 2023: 2023-2024 Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Moderna COVID-19 Vaccine As of October 3, 2023: 2023-2024 Novavax COVID-19 Vaccine The...

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Provider Alert!
28Apr

Provider Alert! Non-Formulary Requests for Obesity Control Drugs

Date: April 28, 2023 Attention: All Providers Effective Date: March 1, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective March 1, 2023, the Health and Human Services Commission (HHSC) will no longer approve medically necessary non-formulary drug requests for obesity control drugs for individuals 21 years and older. This aligns with the Social Security Act, Section 1905, since coverage of these drugs is not included in the Medicaid State Plan. The drugs excluded from...

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Provider Alert!
18Oct

Provider Alert! RSV Fall/Winter Traditional Season Regional Changes Begin October 17

Date: October 17, 2022 Attention: All Providers  Effective Date: October 17, 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: Traditional Respiratory Syncytial Virus (RSV) season is here. Texas Children’s Health Plan (TCHP) would like to let providers know that effective October 17, 2022, the Texas...

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Provider Alert!
08Jul

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: July 6, 2022 Attention: All Providers Effective Date: July 28, 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: Texas Children’s Health Plan (TCHP) would like to inform providers that the Texas Vendor Drug Program (VDP) implemented changes to the state Medicaid drug formulary, effective...

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Provider Alert!
01Nov

Provider Alert! Breyanzi available on Medicaid formulary with prior authorization requirements

Date: October 26, 2021 Attention: Oncologists Effective Date: October 1, 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: Prescribers should be aware that Breyanzi (procedure code Q2054) will be available to members through Texas Medicaid pharmacy benefit effective October 1, 2021. Access will require meeting...

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Provider Alert!
08Oct

Provider Alert! New prior authorization requirements for Burosumab-Twza(Crysvita)

Attention: Nephrologists and Endocrinologists Effective Date: 1/6/2021 Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for burosumab-twza (Crysvita), J0584, with the Texas Medicaid Provider Procedures Manual (TMPPM). Crysvita is a clinician administered drug indicated for members with X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia. Below are the new prior authorization criteria for TCHP members effective 01/06/2021. For initial therapy, the following criteria must be met: The client has a diagnosis of X-linked hypophosphatemia (XLH)...

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Provider Alert!
05Oct

Provider Alert! Concerta® to return to non-preferred status

Attention: All Providers Effective Date: October 16, 2020 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 Vendor Drug Program (VDP) updated the Texas Medicaid formulary for STAR and STAR Kids members. The branded formulations of Concerta (methylphenidate ER) will be moved back to the non-preferred...

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25Jun

Provider Alert! COVID-19/Pharmacy Revised Update from June 8, 2020

Attention: All Providers and Pharmacies Effective Date: June 24, 2020 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 Food and Drug Administration (FDA) has removed the emergency use authorization of hydroxychloroquine (HCQ) and chloroquine due to controlled studies showing no evidence of benefit for mortality...

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Provider Alert!
10Jun

Provider Alert! COVID-19/Hydroxychloroquine Prescribing Revised Update from April 2, 2020

Attention: All Providers and Pharmacies Effective Date: June 9, 2020 Call to action: The Texas State Board of Pharmacy has modified the emergency basis rule when dispensing prescriptions for chloroquine, hydroxychloroquine, mefloquine, and azithromycin.  Physicians no longer have to include the diagnosis on the prescription. Additionally, the rule does not prevent a physician from prescribing one of these drugs for an off-label use.    How this impacts providers and pharmacies:  A diagnosis is no longer required to be provided on prescriptions for the above medications. Prescriptions may be written for off-label use.    Next...

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Provider Alert!
08Jun

Provider Alert! Nitrofurantoin Oral Suspension Drug Shortage

Attention: All Providers and Pharmacies Effective Date: June 12, 2020 Call to action: Drug shortages of nitrofurantoin oral suspension have been identified on the Medicaid and CHIP formularies.  There is only one National Drug Code (NDC) available on the market, and it is not on the Medicaid formulary. There are many other antibiotic choices available on the formulary and prescribers may choose an appropriate alternative based on patient diagnosis and indication for use. How this impacts providers:  Members may reach out to providers...

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