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Updated Provider Requirements for CAR T-Cell Therapy Effective October 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.

Effective for dates of service on or after October 1, 2025, Texas Medicaid will update the provider requirements for chimeric antigen receptor (CAR) T-cell therapy.

Providers and facilities must ensure that clients:

  • Receive all recommended pre-treatment medications.
  • Are closely monitored for a minimum of two weeks after administration, including daily monitoring during the first week.
  • Are instructed to remain near a health care facility for at least two weeks following product administration and to avoid driving during that time.

Texas Medicaid will no longer require health care facilities to:

  • Enroll in Risk Evaluation and Mitigation Strategies (REMS) and comply with the requirements for each CAR T-cell drug administered.
  • Ensure that providers prescribing, dispensing, or administering axicabtagene ciloleucel (Yescarta) and tisagenlecleucel (Kymriah) receive training to manage cytokine release syndrome (CRS) and neurological toxicities.
  • Have at least two doses of tocilizumab per patient on-site for administration within two hours of infusion if needed to treat severe or life-threatening CRS.

TMPPM Updates

On October 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, subsection 6.30, “Chimeric Antigen Receptor (CAR) T-Cell Therapy,” to reflect the revised provider requirements listed above.

TMHP will also update the TMPPM to remove the requirement that an oncologist must prescribe CAR T-cell therapy or participate in the prescription process.

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