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.
CGRP Antagonists- Prophylaxis, Prior Authorization Revision Scheduled for November 22, 2022
Date: November 14, 2022Attention: ProvidersEffective Date: November 22, 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: Texas Children’s Health Plan (TCHP) will revise clinical prior authorization (PA) criteria for calcitonin gene-related peptide (CGRP) Antagonists-Prophylaxis. TCHP will separate renewal criteria from the initiation of therapy. In addition, TCHP will increase the prior authorization approval duration to 365 days.
How this impacts providers: Effective November 22, 2022, the renewal prior authorization criteria will include:
Check for a diagnosis of severe hepatic impairment in the last 365 days or a diagnosis of severe renal impairment or end-stage renal disease in the previous 365 days.
Therapy with a strong CYP3A4 Inhibitor in the last 90 days, therapy with an organic-anion-transporting polypeptides (OATP) inhibitor in the last 90 days.
Concurrent therapy with other CGRP antagonists for prophylaxis of migraines.
