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Update to Initial Prior Authorization Criteria for Beremagene Geperpavec-svdt (Vyjuvek) Effective September 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 September 1, 2024, initial prior authorization criteria will be updated for beremagene geperpavec-svdt (Vyjuvek) procedure code J3401.

The initial criteria for female clients of childbearing age will updated as follows:

  • The prescribing physician attests to counseling female clients of childbearing age regarding the use of an effective method of contraception to prevent pregnancy during treatment with beremagene geperpavec-svdt (Vyjuvek)

Claims that were submitted with dates of service on or after January 1, 2024, for drug wastage for procedure code J3401 will be reprocessed. Providers may receive additional payment, which will be reflected on future Remittance and Status (R&S) Reports.

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