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Age Restriction Updates for Evinacumab-dgnb (Evkeeza) and Fremanezumab-vfrm (Ajovy) for Texas Medicaid and the CSHCN Services Program

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Effective for dates of service on or after December 1, 2025:

  • Evinacumab-dgnb (Evkeeza) (procedure code J1305) will be a benefit for only Texas Medicaid clients who are 1 year of age or older.
  • Fremanezumab-vfrm (Ajovy) (procedure code J3031) will be a benefit for Texas Medicaid and Children with Special Health Care Needs (CSHCN) Services Program clients who are 6 years of age or older.

On December 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, sections 6.6, “Ajovy (Fremanezumab-vfrm),” and 6.51, “Evinacumab-dgnb (Evkeeza).”

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.

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.