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Prior Authorization Requirements for E0788 (Vyalev) Effective January 1, 2027

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On January 1, 2027, the Texas Medicaid & Healthcare Partnership (TMHP) will implement prior authorization requirements for procedure code E0788 (Vyalev).

Prior Authorization Criteria

Prior authorization requests for procedure code E0788 must meet all the following criteria for initiation and continuation of therapy.

Initiation of Therapy

The following requirements must be met for prior authorization for initiation of therapy:

  • The client must have a diagnosis of advanced Parkinson’s disease.
  • The medication is prescribed by or in consultation with a neurologist.
  • The client is responsive to therapy containing levodopa.
  • The client has motor fluctuations even with compliant use of optimized pharmacotherapy for advanced Parkinson’s disease.
  • The client experiences a minimum of 2.5 hours of “off” time per day. Examples of “off” episodes include:
    • Muscle stiffness.
    • Slow movements.
    • Difficulty starting movements.
    • Tremor.
    • Difficulty walking.

Continuation of Therapy

For prior authorization to be considered for continuation of therapy, the client must be established on the medication and exhibit evidence of a positive response.

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.