Update to Recertification or Extension Prior Authorization Requests for Nusinersen (Spinraza)

Date: July 23, 2024
 
Attention: All Providers

Effective date: July 1, 2024

Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after July 1, 2024, recertification and extension prior authorization requests for nusinersen (Spinraza) will be subject to medical director review for additional 12-month periods.

How this impacts providers: Providers should reference the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.10.1.2 “Recertification/Extension Requests (for all Antisense Oligonucleotides),” for additional recertification and extension prior authorization criteria.

Next step for Providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.