Biosynthetic Growth Hormone Products

Traditional Medicaid

Prior approval and documentation of appropriate diagnoses are required. Prior authorization criteria are available online. Refer to the "Pharmacy Prior Authorization" section of the Contact Information chapter of this manual to contact the Texas Prior Authorization Call Center.

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)