Skip to main content

You must have JavaScript enabled in order to access this part of the site. Please enable JavaScript and then reload this page in order to continue.

Adalimumab-afzb (Abrilada) Is a Benefit of Texas Medicaid Effective April 1, 2024

Last updated on

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 April 1, 2024, adalimumab-afzb (Abrilada), procedure code Q5132, is a benefit of Texas Medicaid.

Refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.2, “Adalimumab,” for diagnosis restrictions that apply to all adalimumab procedure codes.

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