TX HHS Form 1355. PCSK9 Inhibitors Standard PA Addendum (Medicaid Fee-for-Service)

The PCSK9 Inhibitors Standard PA Addendum (Medicaid Fee-for-Service) is a form issued by the Texas Health and Human Services (HHS) for prior authorization of PCSK9 inhibitors in Medicaid fee-for-service. This addendum must be completed and submitted along with the Texas Standard Prior Authorization Request Form for Prescription Drug Benefits (TDI Form PDF) to the Texas Prior Authorization Call Center.

This form is designed for healthcare providers to request prior authorization for patients enrolled in Medicaid fee-for-service, ensuring timely access to necessary treatments. The addendum requires prescriber information, patient information, medication history, and laboratory data to support the prior authorization request. Failure to submit this addendum may result in delays or denial of prior authorization.

The PCSK9 Inhibitors Standard PA Addendum is a crucial tool for healthcare providers and patients seeking coverage for PCSK9 inhibitors under Medicaid fee-for-service. By understanding the purpose, audience, and usage of this form, healthcare professionals can efficiently navigate the prior authorization process, ensuring that patients receive necessary treatments in a timely manner.