CSHCN Clinical Prior Authorization

The following classes require prior authorization. Please request prior authorization as instructed below. All submissions must be from the prescribing provider.

  • Cystic Fibrosis products
  • Growth Hormone products
  • HIV products and family planning and pulmonary hypertension drugs
    • The prescribing physician must compose a letter of medical necessity (LMN) on office stationery.  Pharmacy staff must submit the LMN by fax to the CSHCN Service Program.
  • Synagis
    • Please refer to appropriate RSV season information for prior authorization form and instructions.

CSHCN Standardized Prior Authorization Form

Prescribing providers may request prior authorization for the following drugs in the CSHCN Services Program using the Texas Standardized Prior Authorization Form (PDF).

Requests for these products require the submission of the standardized prior authorization form and the above addendums. Failure to submit the addendum with the request will result in prior authorization denial.

Contact

How to contact the Children with Special Health Care Needs (CSHCN) Services program:

By Mail

  • Physical and mailing address:

Texas Health and Human Services Commission
Children with Special Health Care Needs Services Program (MC-1938)
P.O. Box 149347
Austin, TX 78714-9347

By Fax

  • 512-776-7162

By Phone

  • 1-800-252-8023