Date: May 20, 2021
Attention: Geneticists, Hematologists, and Oncologists
Effective Date: June 30, 2021Call to action: Effective June 30, 2021, the Texas Health and Human Services Commission (HHSC) will update the enzymes prior authorization criteria to reflect recent FDA-approved administration changes. This impacts the following agents: Adagen (pegademase bovine), Ceprotin (protein C concentrate), Fabrazyme (agalsidase beta), and Revcovi (elapegademase).
Adagen (J2504 procedure code) has been discontinued by the manufacturer.Ceprotin 400-600 units vial is no longer available through retail pharmacy benefits.
The Ceprotin 400-600 units vial will only be available through the medical benefit (procedure code J2724). The 1000 IU single-use vials will continue to be available through the pharmacy benefit.
Clinical prior authorization updates for other enzymes:
Drug
Procedure Code
Changes effective June 30, 2021
Fabrazyme (agalsidase beta)
J0180
Updated age to > 2 years for confirmed Fabry’s disease
Revcovi (elapegademase)
J3590
Updated for diagnosis of adenosine deaminase severe combined immunodeficiency disease (ADA-SCID)
Next steps for providers: Providers should share this communication with their staff. The updated prior authorization forms will be made available near the effective date on the Navitus website (see Resources link below).
Resources: