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Specialist Requirements Removed for Some CADs Effective August 1, 2022

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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, precertification, 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 August 1, 2022, the following clinician-administered drugs (CADs) will no longer require a specialist prescription or consultation:

  • Antisense oligonucleotides (eteplirsen, golodirsen, and nusinersen)
  • Brexanolone (Zulresso)
  • Burosumab-twza (Crysvita)
  • Crizanlizumab-tmca (Adakveo)
  • Emapalumab-lzsg (Gamifant)
  • Esketamine (Spravato)
  • Ibalizumab-uiyk (Trogarzo)
  • Inebilizumab-cdon (Uplizna)
  • Inotuzumab ozogamicin (Besponsa)
  • Luspatercept-aamt (Reblozyl)
  • Mogamulizumab-kpkc (Poteligeo)
  • Moxetumomab pasudotox-tdfk (Lumoxiti)
  • Tagraxofusp-erzs (Elzonris)
  • Teprotumumab-trbw (Tepezza)

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