Starting December 15, 2025, SafeRide Health will become the new provider for all member rides to doctor appointments and pharmacy visits. After this date, Texas Children’s Health Plan will no longer use MTM for Non Emergency Medical Transportation (NEMT) services.
For other questions, please call Member Services at the number on the back of your member ID card.
A partir del 15 de diciembre de 2025, SafeRide Health será el nuevo proveedor para todos los viajes de los miembros a citas médicas y visitas a la farmacia. Después de esta fecha, Texas Children’s Health Plan ya no usará MTM para los servicios de Transporte Médico No Urgente (NEMT).
Updated Prior Authorization Information for Benlysta (procedure code J0490) and Saphnelo (procedure code J0491)
Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers of prior authorization updates for Belimumab (Benlysta), procedure code J0490, and Anifrolumab-fnia (Saphnelo), procedure code J0491. Effective March 1, 2022, there is no prior authorization requirement for both, and age and diagnosis restrictions are indicated below.
Benlysta (J0490) is indicated to treat the following:
Active, autoantibody-positive, systemic lupus erythematosus (SLE) in clients who are 5 years of age or older, and receiving standard therapy
Adult clients with active Lupus Nephritis who are receiving standard therapy
Providers can now find information about procedure codes J0490 and J0491, in the current Texas Medicaid Provider Manual (TMPPM), Outpatient Drug Services Handbook, section 6.72, “Lupus Treatment Agents.”
Why is this important?
TCHP recognizes we may serve potentially impacted patients in our membership. We want to ensure that the member meets clinical evidence for treatment.
Next step for providers: Providers should refer to the Outpatient Drug Services Handbook chapter of the TMPPM for more details on the clinical policy and prior authorization requirements.
