Skip to main content

Betibeglogene Autotemcel (Zynteglo) to Become a Benefit for Specialty Pharmacy Providers Effective July 1, 2025

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 July 1, 2025, betibeglogene autotemcel (Zynteglo) (procedure code J3393) may be distributed through specialty pharmacy providers.

Prior authorization is required and may be approved for a duration of 12 months.

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