Livmarli Clinical Prior Authorization Criteria Revision Scheduled for May 30, 2023

Date: April 11, 2023

Attention: All Providers

Effective Date: May 30, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective May 30, 2023, the Health and Human Services Commission (HHSC) will update prior authorization criteria for Livmarli that meets the recent FDA-approved age indication.

How this impacts providers: Starting May 30, 2023, TCHP will expand the age requirement to pediatric patients three months and older.

Next steps for providers: Prescribers should share this communication with their staff. Provider must submit documentation (such as office chart notes, lab results, or other clinical information) supporting that the member has met all approval criteria in support for Livmarli approval. Updated PA forms can be found on Navitus.

Note: As always, 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 TCHP Pharmacy at: tchppharmacy@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.