TCHP Prior Authorization Requirement

Subject: TCHP Prior Authorization Requirement Effective April 1, 2018, TCHP will be updating the prior authorization listing. This notice will serve as your 90-day advance notification of the change. Please note there are some key changes for providers. Removed from the list and will no longer require prior authorization:

• Walkers
• Vision Care, medically necessary

New to the list:

• High cost injectable drugs (>$75K per dose) in an outpatient level of care require prior authorization. Examples include: Kymriah, Spinraza, Exondys

Updates:

• Progesterone therapy has been updated to Hydroxyprogesterone caproate injections.
• Transplant evaluation has been updated to transplants including solid organ and bone marrow.

The new TCHP prior authorization list will also be posted at: http://www.tchp.us/for-providers/provider-resources If there are further questions, please contact the Provider Relations Department at 1-800-731-8527