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Additional Indication for Benralizumab (Fasenra) Effective December 1, 2024, for Texas Medicaid

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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 December 1, 2024, benralizumab (Fasenra) will also be indicated for adult clients who are 18 years of age or older with eosinophilic granulomatosis with polyangiitis (EGPA).

Refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.88.2, “Benralizumab,” for additional indications for benralizumab (Fasenra).

Prior Authorization for Clients with EGPA

Prior authorization will be considered when the following criteria are met:

  • The client is 18 years of age or older.
  • The client has a medical history of asthma.
  • The client has a diagnosis of EGPA (diagnosis code M301).
  • The client has a refractory disease or has had a history of EGPA relapse.

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