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, 2021Providers 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 Molononal Antibody Agents for Asthma clinical criteria guide on July 12, 2021, in accordance with the US Food and Drug Administration (FDA) approved indications. Texas Children’s Health Plan (TCHP) will align with this guidance from HHSC. How this impacts providers: HHSC will change the age criteria to match the FDA-approved age indication for the Nucala prefilled autoinjector and prefilled syringe. Other formulations of Nucala are indicated as maintenance treatment for patients six years and older with severe eosinophilic asthma. However, the prefilled autoinjector and the prefilled syringes are only FDA-approved for at-home use for adults and adolescents age 12 and older. Next steps for providers:  Providers should share this communication with their staff and use the updated prior authorization forms. Reference: http://www.thecheckup.org/2021/04/08/provider-alert-additional-guidance-for-hepatitis-c-drug-prior-authorization-changes-effective-march-1-2021/ Resources:

1. Navitus TX Medicaid Prior Authorization Forms

  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.