Clinical Prior Authorization Criteria Updates

Date: December 16, 2024

Attention: Providers

Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that the Texas Health and Human Services (HHSC) has updated multiple clinical prior authorization criteria guides.

How this impacts providers: HHSC reviewed the following clinical prior authorization criteria guides and made updates. The list of revisions is on available on Navitus page.

The following drug categories are impacted:

ADD/ADHD
Aliskiren-Containing Agents
Antimigraine-Triptans
Appetite Suppressant Agents
Buprenorphine Agents
CGRP Antagonists, Prophylaxis
CNS Stimulants
Cortisol Receptor Antagonists
Cytokine and CAM Antagonists
Diclofenac Topical
DDP-4 Inhibitors
Duplicate Therapy
Erthropoiesis-Stimulating Factors
Evrysdi
Fentanyl Agents
Gabapentin Agents

GI Motility Agents
Growth Hormone Agents
HP Acthar
Immunomodulator Agents for Dry Eye
Inhaled Antibiotics
Lupus Agents
Monoclonal Antibody Agents
Opiate Overutilization
Opiate/Benzodiazepine/Muscle Relaxant Combinations
Oxycodone Extended-Release Agent
Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors
Voxogo

Next step for Providers: Providers should visit the Navitus page to become familiar with the changes and share this information with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org

For access to all provider alerts: https://www.texaschildrenshealthplan.org/provideralerts