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TMPPM Outpatient Drug Services Handbook Correction for Sickle Cell Disease Gene Therapy

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The Texas Medicaid & Healthcare Partnership (TMHP) is making a correction to the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, subsection 6.112.1, “Prior Authorization Requirements.”

The following duplicate statement will be removed from the list of requirements for the administration of exagamglogene autotemcel (Casgevy) in the November TMPPM release:

  • The client has a history of requiring at least 100 mL/kg/year or 10 units/year of red blood cell (RBC) transfusions in the past 24 months.

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

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.