Provider Alert! Clinical Prior Authorization Updates for EnzymesTexas Children's Health Plan
Date: May 20, 2021
Attention: Geneticists, Hematologists, and Oncologists
Effective Date: June 30, 2021
Call to action: Effective June 30, 2021, the Texas Health and Human Services Commission (HHSC) will update the enzymes prior authorization criteria to reflect recent FDA-approved administration changes. This impacts the following agents: Adagen (pegademase bovine), Ceprotin (protein C concentrate), Fabrazyme (agalsidase beta), and Revcovi (elapegademase).
Adagen (J2504 procedure code) has been discontinued by the manufacturer.
Ceprotin 400-600 units vial is no longer available through retail pharmacy benefits.
The Ceprotin 400-600 units vial will only be available through the medical benefit (procedure code J2724). The 1000 IU single-use vials will continue to be available through the pharmacy benefit.
Clinical prior authorization updates for other enzymes:
|Drug||Procedure Code||Changes effective June 30, 2021|
|Fabrazyme (agalsidase beta)||J0180||Updated age to > 2 years for confirmed Fabry’s disease|
|Revcovi (elapegademase)||J3590||Updated for diagnosis of adenosine deaminase severe combined immunodeficiency disease (ADA-SCID)|
Next steps for providers: Providers should share this communication with their staff. The updated prior authorization forms will be made available near the effective date on the Navitus website (see Resources link below).
If you have any questions, please email TCHP Pharmacy Department at: email@example.com.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.