New Rewards Coming Soon!¡Se vienen nuevas recompensas!
Our Healthy Rewards Program is getting an update in September! For a sneak peek of all the changes - including new rewards and ways to redeem them - please click here.
¡Nuestro Programa Healthy Rewards tendrá su actualización en septiembre! Para ver un adelanto de todos los cambios, incluyendo nuevas recompensas y formas de canjearlas, haz clic aquí.
Prior Authorization Criteria Updates for Yescarta and Tecartus
Date: June 1, 2022Attention: All ProvidersEffective Date: July 1, 2022Providers 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 Health and Human Services Commission (HHSC) will update prior authorization criteria for Yescarta (Q2041) and Tecartus (Q2053) effective July 1, 2022. The Food and Drug Administration (FDA) approved additional indications for Yescarta and Tecartus. The following are the newly approved indications by the FDA:
In addition to its current indication, Tecartus is now approved to treat adult clients 18 and older with B-cell Precursor Acute Lymphoblastic Leukemia (ALL).
In addition to its current indication, Yescarta is now approved to treat adult clients 18 and older who have large B-cell lymphoma that is refractory to first-line chemoimmunotherapy or that relapses within 12 months of first-line chemoimmunotherapy.
How this impacts providers: Prior authorization approval for Tecartus (brexucabtagene autoleucel) treatment in adult clients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL) will be considered once all the following criteria are met:
Client is 18 or older
Client has relapsed or refractory B-cell precursor ALL
Client has histologically confirmed diagnosis of one of the following:
4 C91.00, C91.01, or C91.02.
Client does not have primary central nervous system lymphoma/disease
Client has not received prior CD-19 directed CAR-T therapy
Client does not have an active infection or inflammatory disorder
Prior authorization approval for Yescarta (axicabtagene ciloleucel) treatment in adults with large B-cell lymphoma that is refractory to first-line chemoimmunotherapy or that relapses within 12 months of first-line chemoimmunotherapy will be considered once all the following criteria are met:
Client is 18 or older
Client has large B-cell lymphoma that is refractory to first-line chemoimmunotherapy or that relapses within 12 months of first-line chemoimmunotherapy
Client has histologically confirmed diagnosis of one of the following:
