Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
Effective for dates of service on or after December 1, 2019, the age limitation for Mepolizumab injections will change for clients who are six years of age or older.
Prior authorization for Mepolizumab will be considered for clients who are six years of age or older with severe asthma with eosinophilic phenotype.
For more information, call the TMHP Contact Center at 800-925-9126.