Form 1143, Cystic Fibrosis Treatment Products Authorization Request (CSHCN)

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Effective Date: 10/2023


Updated: 10/2023


HHSC requires prior authorization for cystic fibrosis treatment agents for people enrolled in the Children with Special Health Care Needs (CSHCN) Services Program.


Prescribing providers complete and submit this and the Texas Standard Prior Authorization Request Form for Prescription Drug Benefits. Failure to submit both forms may cause delays or denial of authorization.

The provider must document why any information is unavailable and then submit the form annually, certifying the client requires these medications. Providers must supply medical necessity documentation for clients with a diagnosis other than cystic fibrosis.

Fax: 512-776-7238


Texas Health and Human Services 
Children with Special Health Care Needs Services Program (MC-1938) 
P.O. Box 149030 
Austin, TX 78714-9347


Refer comments or questions about this form to the CSHCN Services Program at 800-252-8023.