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

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Clinical Prior Authorization Criteria Updates

Date: December 16, 2024

Attention: Providers

Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that the Texas Health and Human Services (HHSC) has updated multiple clinical prior authorization criteria guides. 

How this impacts providers: HHSC reviewed the following clinical prior authorization criteria guides and made updates. The list of revisions is on available on Navitus page.

The following drug categories are impacted:

  • ADD/ADHD
  • Aliskiren-Containing Agents
  • Antimigraine-Triptans
  • Appetite Suppressant Agents
  • Buprenorphine Agents
  • CGRP Antagonists, Prophylaxis
  • CNS Stimulants
  • Cortisol Receptor Antagonists
  • Cytokine and CAM Antagonists
  • Diclofenac Topical
  • DDP-4 Inhibitors
  • Duplicate Therapy
  • Erthropoiesis-Stimulating Factors
  • Evrysdi
  • Fentanyl Agents
  • Gabapentin Agents
  • GI Motility Agents
  • Growth Hormone Agents
  • HP Acthar
  • Immunomodulator Agents for Dry Eye
  • Inhaled Antibiotics
  • Lupus Agents
  • Monoclonal Antibody Agents
  • Opiate Overutilization
  • Opiate/Benzodiazepine/Muscle Relaxant Combinations
  • Oxycodone Extended-Release Agent
  • Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors
  • Voxogo

Next step for Providers: Providers should visit the Navitus page to become familiar with the changes and share this information with their staff. 

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org

For access to all provider alerts: https://www.texaschildrenshealthplan.org/provideralerts