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 September 1, 2020, benralizumab, mepolizumab, and reslizumab benefits will change for Texas Medicaid.
A six-month trial of omalizumab therapy that resulted in inadequate response will no longer be required when requesting prior authorization for benralizumab, mepolizumab, or reslizumab.
Providers may refer to the current Texas Medicaid Provider Procedures Manual, Clinician-Administered Drugs Handbook, subsection 43, “Monoclonal Antibodies—Asthma and Chronic Idiopathic Urticaria,” for additional benralizumab, mepolizumab, and reslizumab benefit information.
For more information, call the TMHP Contact Center at 800-925-9126.