Clinical Prior Authorization for Xenical No Longer Required After September 12, 2022

Date: August 19, 2022Attention: All Providers Subject: Clinical Prior Authorization for Xenical No Longer Required After September 12, 2022 Effective Date: September 12, 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 beginning September 12, 2022, the Health and Human Services Commission (HHSC) will retire the Xenical (Orlistat) prior authorization forms. How this impacts providers: Medicaid covers Xenical (Orlistat) for the indication of obesity management and is not dependent on a hyperlipidemia condition. HHSC will retire the following Xenical (Orlistat) clinical prior authorization requests:

• Medicaid Xenical Clinic Prior Authorization(HHS Form 1331)
• Medicaid Xenical Prior Authorization Addendum(HHS Form 1333)*

*Used in conjunction with the Standard Prior Authorization Request (TDI Form NOFR002) Next steps for providers: Providers 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