Skip to main content

You must have JavaScript enabled in order to access this part of the site. Please enable JavaScript and then reload this page in order to continue.

Updated Prior Authorization Criteria for Benralizumab (Fasenra)

Last updated on

Effective for dates of service on or after October 1, 2026, Texas Medicaid will update the prior authorization criteria for benralizumab (Fasenra).

The U.S. Food & Drug Administration (FDA) has approved benralizumab (Fasenra) (procedure code J0517) as a treatment for adult and pediatric clients who are 12 years of age or older with hypereosinophilic syndrome (HES) without an identifiable non-hematologic secondary cause.

Prior Authorization Requirements

The Texas Medicaid & Healthcare Partnership (TMHP) will consider prior authorization requests for benralizumab (Fasenra) for HES if the client meets the following criteria:

  • The client is 12 years of age or older.
  • The client has a diagnosis of HES without identifiable non-hematologic secondary cause (diagnosis code D72110, D72111, D72118, or D72119).
  • Documentation supporting medical necessity for treatment of benralizumab (Fasenra) must be submitted with the prior authorization request and meet the following criteria:
    • The client has a diagnosis of HES or exhibits signs and symptoms of HES without any non-hematologic secondary cause.
    • The client has a history of two or more HES flares within the past 12 months before the start of benralizumab (Fasenra) therapy. A flare is defined as worsening clinical symptoms or blood eosinophil counts requiring an increase in prior therapy.
    • The prescribing provider attests that the client has been on a stable dose of HES therapy which includes, but is not limited to, oral corticosteroids, immunosuppressives, and cytotoxic therapy.

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.