Clinical Criteria Revision for Cibinqo Effective May 31, 2023

Date: April 25, 2023

Attention: All Providers

Effective Date: May 31, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective May 31, 2023, the Health and Human Services Commission (HHSC) will expand coverage for Cibinqo to adolescents 12-18 years of age due to a recent U.S. Food and Drug Administration (FDA) approval. Cibinqobelongs to a class of medications called Janus Kinase (JAK) Inhibitors and is indicated for the treatment of adults with refractory moderate-to-severe atopic dermatitis whose disease is not adequately controlled with other systemic drug products, including biologics, or when use of other therapies is contraindicated.

How this impacts providers: Starting May 31, 2023, TCHP will expand the age requirement to adolescents 12-18 years of age.

Next steps for providers: Prescribers should share this communication with their staff. Providers 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 Cinbinqo approval. Updated prior authorization forms can be found on Navitus.

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 Network Management at providerrelations@texaschildrens.organd TCHP Pharmacy at tchppharmacy@texaschildrens.org.For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.