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 November 1, 2020, prior authorization criteria for burosumab-twza (Crysvita) will be updated for Texas Medicaid.
The client age criteria for treatment of X-linked hypophosphatemia will change from one year of age or older to six months of age or older.
Burosumab-twza (Crysvita) will also be a benefit for treatment of fibroblast growth factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors. For initial prior authorization approval, the following criteria must be met:
- The client is two years of age or older.
- The client has a diagnosis of FGF23-related hypophosphatemia produced by an underlying tumor that cannot be localized or is not amenable to surgical excision.
- 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 more information, call the TMHP Contact Center at 800-925-9126.