HHSC to Implement Pulmonary Hypertension Agents Clinical Prior Authorization on July 27, 2023

Date: June 9, 2023

Attention: All Providers

Effective Date: July 27, 2023

Call to action:Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 27, 2023, Texas Health and Human Services (HHSC) will be implementing clinical prior authorization criteria for Pulmonary Hypertension Agents.

How this impacts providers: Starting July 27, 2023, TCHP will implement the Pulmonary Hypertension Agents clinical prior authorization criteria. Updated prior authorization (PA) forms will be accessible on Navitus. It is crucial for all providers to familiarize themselves with these updated guidelines to ensure compliance and facilitate a smooth prior authorization process.

Next steps for providers Prescribers should share this communication with their staff. Providers must stay up-to-date on the latest restrictions and indications for these agents to ensure appropriate use and maximize patient outcomes. Provider must submit documentation (such as office chart notes, lab results, other pertinent clinical information, etc.) supporting that the member has met all appropriate criteria in support for medication approval.

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.