Biosynthetic Growth Hormone Products

Traditional Medicaid

HHSC requires prior approval with documentation of an appropriate diagnosis. Refer to the Growth Hormone clinical prior authorization criteria document for more information.

CSHCN Services Program

HHSC requires prescribing providers to submit prior authorization documentation of appropriate diagnoses. The prescribing provider must complete one of the following sets of forms:

  • Growth Hormone Products Authorization Request (HHS Form 1312)
  • Texas Standard Prior Authorization Form for Prescription Drug Benefits (Texas Department of Insurance Form TDI NOFR002) and Growth Hormone Agents - Addendum (HHS 1327)