New Rewards Coming Soon!¡Se vienen nuevas recompensas!
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.
Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective February 22, 2024, the Texas Health and Human Services (HHSC) allows coverage for Omnipod 5 through pharmacy benefit for both CHIP and Medicaid formularies. Members can obtain one (1) Omnipod 5 G6 intro kit per 365 days, and fifteen (15) units of Omnipod 5 C6 PODS per 30 days. HHSC is not requiring clinical prior authorization for Omnipod 5 at this time.
How this impacts providers: The change will allow providers to prescribe Omnipod 5 through pharmacy benefit. Other insulin delivery systems and glucose monitors, including Omnipod DASH, must continue to be billed through the medical benefit.
Although HHSC has not implemented prior authorization criteria at this time, it is possible they will require criteria similar to the medical benefit (see below). Providers should adhere to the medical criteria in the event of a future benefit update from HHSC. The Provider Alert with the latest update is: