Removal of Specialist Requirements from CAD Clinical Policies and Prior Authorization Criteria

Date: July 13, 2022Attention: ProvidersEffective Date: August 1, 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 updating the prior authorization criteria for some clinician administered drugs. How this impacts providers: HHSC will no longer require the prescription include consultation with or be written by a disease state specialist in the prior authorization policy and will remove this specialist requirement from the following CAD clinical policies and prior authorization criteria:

Antisense Oligonucleotide
Brexanolone
Burosumab-Twas
Crinzanizumab-Tmca
Emapalumab-Izsg
Esketamine
Ibalizumab-Uiyk
Inebilizumab-Cdon
Inotuzumab Ozogamicin
Luspatetcept-Aamt
Mogamulizumab-Kpkc
Moxetumomab Pasudotox-Tdfk
Tagraxofuso-Erzs
Teprotumumab-Trbw

Next steps for providers: Providers should adjust their prescribing patterns and 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.