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Removal of Certain Drugs From the TMPPM on June 1, 2025

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

On June 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will remove the following subsections from the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook:

  • Subsection 6.18, “Brexanolone (Zulresso)” – procedure code J1632 will no longer have a rebate-eligible National Drug Code (NDC), effective June 1, 2025.
  • Subsection 6.77, “Lefamulin (Xenleta)” – procedure code J0691 currently does not have a rebate-eligible NDC.
  • Subsection 6.91, “Moxetumomab Pasudotox-tdfk (Lumoxiti)” – procedure code J9313 will no longer have a rebate-eligible NDC, effective June 1, 2025.

For more information, call the TMHP Contact Center at 800-925-9126.