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Update to TMPPM Outpatient Drug Services Handbook Effective November 1, 2021

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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.

Beginning November 1, 2021, TMHP will update benefit language in the Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook.

The following outpatient drug services will be updated:

  • Abatacept (Orencia)
  • Ado-trastuzumab emtansine (Kadcyla)
  • Alglucosidase Alfa (Myozyme)
  • Antisense oligonucleotides
  • Brexanolone (Zulresso)
  • Burosumab-Twza (Crysvita)
  • Crizanlizumab-tmca (Adakveo)
  • Emapalumab-lzsg (Gamifant)
  • Esketamine (Spravato)
  • Hematopoietic injections
  • Ibalizumab-uiyk (Trogarzo)
  • Inebilizumab-cdon (Uplizna)
  • Injections – Clofarabine
  • Inotuzumab ozogamicin (Besponsa)
  • Luspatercept-aamt (Reblozyl)
  • Mepsevii (Vestronidase alfa-vjbk)
  • Mogamulizumab-kpkc (Poteligeo)
  • Monoclonal antibodies
  • Moxetumomab pasudotox-tdfk (Lumoxiti)
  • Onasemnogene abeparvovec-xioi (Zolgensma)
  • Patisiran (Onpattro)
  • Tagraxofusp-erzs (Elzonris)
  • Teprotumumab-trbw (Tepezza)
  • Vitamin B12 (vyanocobalamin) injections
  • Voretigene neparvovec-rzyl (Luxturna)

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