Provider Alert! New prior authorization requirements for Burosumab-Twza(Crysvita)tcph
Attention: Nephrologists and Endocrinologists
Effective Date: 1/6/2021
Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for burosumab-twza (Crysvita), J0584, with the Texas Medicaid Provider Procedures Manual (TMPPM). Crysvita is a clinician administered drug indicated for members with X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia.
Below are the new prior authorization criteria for TCHP members effective 01/06/2021.
For initial therapy, the following criteria must be met:
- The client has a diagnosis of X-linked hypophosphatemia (XLH) (diagnosis code E8330 or E8331) that is supported by one of the following:
- Confirmed phosphate regulating gene with homology to endopeptidases located on the X chromosome (PHEX-gene) mutation
- Serum fibroblast growth factor-23 (FGF23) level >30 pg/ml
- The client is six months of age or older
- The prescriber discontinues any oral phosphate or active vitamin D analog supplementation at least one week prior to starting burosumab-twza (Crysvita) therapy.
- The prescriber agrees to measure serum phosphate throughout therapy and withhold medication when serum phosphorus is above 5 mg/dl.
- The client has a diagnosis of fibroblast growth factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors that cannot be localized or are not amenable to surgical excision.
- The client is two years of age or older.
- The prescriber discontinues any oral phosphate or vitamin D analog supplement at least two weeks prior to starting burosumab-twza (Crysvita) therapy.
- The prescriber agrees to measure serum phosphate throughout therapy.
For both indications:
For renewal or continuation of therapy, the following criteria must be met:
- Previous treatment of Burosumab-twza (Crysvita)
- Provider continues to monitor serum phosphate level
- Documentation from the provider that:
- Patient has achieved normal levels of phosphate OR
- Patient has demonstrated positive clinical response to Burosumab-twza (Crysvita) (e.g., enhanced height velocity, improvement in askeletal deformity, reduction of fractures, and reduction of generalized bone pain)
How this impacts providers: Prescribers should adjust their prescribing patterns accordingly and communicate these changes to their staff.
Next steps for providers: Providers should communicate these changes to their staff.
If you have any questions, please email Provider Network Management at: email@example.com.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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