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CHIP State Plan Amendment Reducing Insulin Copays for Certain Members
Date: February 28, 2023
Attention: Primary Care Providers and Endocrinologists
Effective date: June 1, 2023
Providers 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: The copay charge for brand insulin drugs will be reduced beginning June 1, 2023 from $35 to $25 for CHIP members with incomes above 151% up to and including 201% of the federal poverty level (FPL). Changes to the CHIP State Plan are as follows:
| Above 151% up to and including 186% of FPL | Charge |
| Brand Drug | $25 for insulin, $35 for all other drugs** |
| Above 186% up to and including 201% of FPL | Charge |
| Brand Drug | $25 for insulin, $35 for all other drugs** |
| **Copays for insulin cannot exceed $25 per prescription for a 30-day supply. |
Background information: This copay change was submitted by the Health and Human Services Commission as a CHIP State Plan Amendment to the Centers for Medicare & Medicaid Services and has been approved, which allows CHIP managed care organizations to implement the reduced copay. This change is to ensure compliance with the passing of Senate Bill 827 during the 87th legislative session which amended Chapter 1358, Section 1358.103 of the Texas Insurance Code.
How this impacts providers: Staff should reference the member’s ID card and/or online benefit information for copay amount.
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.