Provider Alert! Clinical Prior Authorization Updates for Enzymes
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).
Resources:
If you have any questions, please email TCHP Pharmacy Department at: tchppharmacy@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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