Revision to Makena Authorization Request Form 1345 Scheduled for June 10

Date: June 3, 2022 Attention: OB-GYN Providers Effective Date: June 10, 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:  On June 10, 2022, Health and Human Services Commission (HHSC) will revise the Makena (hydroxyprogesterone caproate injection) authorization request form because the brand name Makena 250 mg/ml is no longer eligible for Centers for Medicare and Medicaid Services rebates. How this impacts providers: HHSC removed the brand name Makena 250 mg/ml from the Texas Medicaid Formulary and the clinical prior authorization criteria guide. For patients requiring the 250mg dosing, the generic hydroxyprogesterone 250 mg/ml vial remains covered on Texas Medicaid Formulary with prior authorization criteria. Prior authorization criteria remains the same.  

Drugs Requiring Prior Authorization

HYDROXYPROGEST 1250 MG/5 ML

HYDROXYPROGEST 250 MG/ML VIAL

MAKENA 275 MG/1.1 ML AUTOINCT

  Next steps for providers: Prescribers should adjust their prescribing patterns accordingly and communicate these changes to their staff. Resource: https://paxpress.txpa.hidinc.com/makena.pdfIf 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