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:

1. 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.
2. 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.
3. Concurrent therapy with other CGRP antagonists for prophylaxis of migraines.

Next steps for providers: Updates PA forms can be found on Navitus page starting November 22, 2022. Providers should share this communication with their staff. 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.