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Texas Medicaid Prior Authorization Update for Clofarabine Effective January 1, 2026

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Texas Medicaid will update the prior authorization criteria for clofarabine (procedure code J9027), effective for dates of service on or after January 1, 2026.

Texas Medicaid may approve prior authorization of clofarabine only for clients who are 1 through 21 years of age.

Providers can refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.31.1, “Prior Authorization for Clofarabine,” for additional prior authorization criteria.

For more information, call the Texas Medicaid & Healthcare Partnership (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.