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Updated Prior Authorization Criteria for Therapy with Burosumab-Twza (Crysvita) Effective July 1, 2024

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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 July 1, 2024, Texas Medicaid will update the prior authorization criteria for renewal or continuation therapy with burosumab-twza (Crysvita).

Documentation from the physician must confirm that the client has demonstrated a positive clinical response to burosumab-twza (Crysvita), such as enhanced height velocity, improvement in a skeletal deformity, reduction of fractures, and reduction of generalized bone pain.

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