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Update to Recertification or Extension Prior Authorization Requests for Nusinersen (Spinraza) 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, recertification and extension prior authorization requests for nusinersen (Spinraza) will be subject to medical director review for additional 12-month periods.

Refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.10.1.2 “Recertification/Extension Requests (for all Antisense Oligonucleotides),” for additional recertification and extension prior authorization criteria.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.