Updated Prior Authorization Criteria for Therapy with Burosumab-Twza (Crysvita)

Date: July 25, 2024

Attention: All Providers

Effective date: July 1, 2024

Call to action: Texas Children’s Health Plan’s prior authorization (PA) criteria for renewal or continuation therapy with burosumab-twza (Crysvita) has changed, effective for dates of service on or after July 1, 2024.

TCHP’s criteria for determining medical necessity for renewal or continuation therapy with burosumab-twza (Crysvita) is aligned with Texas Medicaid policy, as outlined in Texas Medicaid Provider Procedures Manual including the following update:

Clinical documentation from the physician must confirm that the member has demonstrated a positive clinical response to burosumab-twza (Crysvita), such as enhanced height velocity, improvement in a skeletal deformity, reduction of fractures, and reduction of generalized bone pain.

How this impacts providers and next steps:

Providers should review the updated Texas Medicaid policy for burosumab-twza (Crysvita) as outlined in Texas Medicaid Provider Procedure Manual Outpatient Drug Services Handbook available here and share this update 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.