TX HHS Form 1354. PCSK9 Inhibitors Authorization Request (Medicaid Fee-for-Service)

The PCSK9 Inhibitors Authorization Request Form (TX HHS Form 1354) is a crucial document for healthcare providers in Texas. This form helps solve the problem of obtaining authorization for patients to receive PCSK9 inhibitors, which are FDA-approved medications used to treat high cholesterol. The form is typically filled out by healthcare providers who need to request approval from Medicaid Fee-for-Service for their patients' treatment with these medications.

The form requires specific information, including patient demographics, diagnosis, and current treatment regimen. It also outlines the treatment approval criteria for Praluent (Alirocumab) and Repatha (Evolocumab), which include conditions such as primary hyperlipidemia or clinical atherosclerotic cardiovascular disease. The form also specifies the responsibilities of healthcare providers in documenting patient treatment failure and demonstrating clinical response to PCSK9 inhibitor therapy.

The form is used in situations where patients have not achieved adequate LDL-C levels with current treatments, and their healthcare provider needs to request approval for PCSK9 inhibitor therapy. Key features of the form include the required information and conditions outlined above, as well as the maintenance therapy approval criteria for Praluent or Repatha. By filling out this form, healthcare providers can obtain authorization for their patients' treatment with PCSK9 inhibitors and ensure they receive the necessary medications to manage their high cholesterol.

• The form is used by healthcare providers in Texas to request authorization for PCSK9 inhibitor therapy for patients with primary hyperlipidemia or clinical atherosclerotic cardiovascular disease.
• The form requires specific information, including patient demographics, diagnosis, and current treatment regimen.
• The form outlines the treatment approval criteria for Praluent (Alirocumab) and Repatha (Evolocumab).