Cold and flu season Temporada de influenza y resfriados

ALERT: Stay healthy this cold and flu season! Learn more

ALERTA: ¡Mantente sano durante esta temporada de influenza y resfriados! Más información

New Website! ¡Nuevo sitio web!

ALERT: We have made the Texas Children’s Health Plan website even easier to use! Click here to learn more.

ALERTA: ¡Ahora el sitio web de Texas Children’s Health Plan es aún más sencillo de usar! Haz clic aquí para más información.

Enfamil shortage updates Escasez de Enfamil Reguline

ALERT: Shortage of Enfamil products until October 31, 2024. Learn more.

ALERTA: Escasez de productos de Enfamil hasta el 31 de octubre de 2024. Más información.

Change Healthcare Incident Change Healthcare incidente

Search

Implementation of Hormonal Therapy Agents Clinical Prior Authorization

Date: May 28, 2024
Attention: All Providers

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that on May 17, 2024 Health and Human Services Commission (HHSC) published an updated Hormonal Therapy Agents Clinical prior authorization criteria guide that was originally implemented on March 1, 2024.

Previous TCHP provider alerts on hormonal therapy agents:

Clinical Implementation of Hormonal Therapy Agents Clinical Prior Authorization Effective March 1, 2024: https://www.thecheckup.org/2024/02/02/provider-alert-clinical-implementation-of-hormonal-therapy-agents-clinical-prior-authorization-effective-march-1-2024/

Clinical Criteria Implementation for Enzyme Replacement Hormonal Therapy Agents effective May 1, 2024: https://www.thecheckup.org/2024/04/18/provider-alert-clinical-criteria-implementation-for-enzyme-replacement-hormonal-therapy-agents-effective-may-1-2024/

How this impacts providers: May 17, 2024 updates include the following.

  • Adding GCNs for:
    • Methitest (10411)
    • Oxandrolone (10561, 18265)
    • Synarel (84354)
    • Testosterone Cypionate (10194, 10191)
    • Lyllana (28840, 28841, 28842, 28843, 28846)
    • Alora (28840, 28841, 28842, 28843)
    • Minivelle (28840, 28841, 28842, 28843, 28846)

  • Correcting GCN for:
    • Kyzatrex from 52948 to 52648

  • Removing GCN for:
    • Lupron Depot-Ped 45 mg 6mo kit (54034)

Next step for Providers: Providers are strongly encouraged to follow the guidance as specified above. 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 for medication approval.

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.