Flu Season Alert!Alerta de temporada de influenza:
Don’t let germs win this season – protect yourself and your family!
The flu vaccine is your best defense against flu and related complications – PLUS, it is a covered benefit for Texas Children’s Health Plan members! Learn more!
¡No permitas que los gérmenes ganen esta temporada! ¡Protégete a ti y a tu familia!
La vacuna contra la influenza es tu mejor defensa contra la influenza y sus complicaciones. Además, ¡es un beneficio cubierto para los miembros de Texas Children's Health Plan! Aprende más
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:
