All MCOs: Dupixent, Evrysdi, and Qelbree Clinical Prior Authorization Criteria Updates

Date: July 13, 2022Attention: ProvidersEffective Date: August 2, 2022Providers 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: HHSC is revising the prior authorization (PA) criteria for the following drugs: Dupixent, Evrysdi and Qelbree. How this impacts providers: HHSC made the following revisions:

• Dupixent clinical PA criteria:
  • Added diagnosis of eosinophilic esophagitis for clients ≥ 12 years of age
  • Updated age to ≥ 6 months for clients with atopic dermatitis

• Evrysdi clinical PA criteria
  • Updated age for Evrysdi to < 65 years

• Qelbree clinical PA criteria
  • Updated age for Qelbree (recently updated by the FDA; now indicated for patients ≥ 6 years)
  • Updated Qelbree maximum quantity to ≤ 3 units per for clients ≥ 18

Next steps for providers: Updated PA forms can be found on Navitus. Prescribers should 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: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.