TX HHS Form 1356. Texas Medicaid Xyrem Prior Authorization Request

The Texas Medicaid Xyrem Prior Authorization Request Form (TX HHS Form 1356) is a standardized document issued by the Texas Health and Human Services (HHS). This form is designed for healthcare providers to request prior authorization for patients enrolled in Medicaid fee-for-service who require treatment with Xyrem, a medication used to treat narcolepsy.

The purpose of this form is to ensure that patients receive timely and appropriate care while also ensuring that the use of Xyrem aligns with established guidelines and protocols. The form requires prescribers to provide specific information about their patients, including details on their medical history, current treatment plans, and potential contraindications or intolerances to alternative medications.

The Texas Prior Authorization Call Center at 866-469-8590 is responsible for processing completed forms and making prior authorization decisions. It is essential that healthcare providers submit complete and accurate forms to avoid delays in patient care or denial of treatment. This form is only applicable to patients enrolled in Medicaid fee-for-service; managed care plans have their own prior authorization processes.