Removal of Specialist Requirement from Clinical Prior Authorization Criteria

Date: January 28, 2022 Attention: Providers Effective Date: January 3, 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: Effective January 3, 2022, HHSC removed the specialist requirement from the following clinical prior authorization criteria:

• CGRP Antagonist, Acute
• CGRP Antagonists, Chronic
• Emflaza
• Ophthalmic Immunomodulators
• Palforzia
• Transthyretin Agents
• VMAT2 Inhibitors
• Wakix
• Xyrem/Xywav
• Zelboraf

How this impacts providers: Providers will need to use updated prior authorization forms and communicate these changes to their staff. Resources:Navitus TX Medicaid Prior Authorization FormsIf you have any questions, please email TCHP PharmacyDepartment at: TCHPPharmacy@texaschildrens.org. For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.