Implementation of Hereditary Angioedema (HAE) Agents Clinical Prior Authorization for Fee for Service Scheduled for April 11

Date: May 10, 2023

Attention: Providers

Effective Date: April 11, 2023

Call to action: Effective April 11, 2023 Texas Health and Human Services Commission (HHSC) added Takhzyro generic code (GCN) 39478 to the drugs requiring Hereditary Angioedema (HAE) clinical prior authorization for clients enrolled in Medicaid Fee-For-Service.

How this impacts providers: Prescribers will now have to submit a prior authorization for Takhzyro^® for their Medicaid fee-for-service population.

Next steps for providers: Prescribers should share this communication with their staff. Provider must submit documentation (such as office chart notes, lab results, other pertinent clinical information, etc) supporting that the member has met all appropriate criteria in support for Takhzyro^® approval. Updated prior authorization (PA) forms can be found on Navitus page. Prescribers can also find the updated prior authorization HAE criteria guide at: paxpress.txpa.hidinc.com/HAE.pdf.

Note: If request is for a non-FDA approved dose or indication, medical rational must be submitted in support of therapy (such as high-quality peer reviewed literature, acceptable compendia or evidence based practice guidelines) and exceptions will be considered on a case-by-case basis.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.