Texas Medicaid Prior Authorization Update Zolgensma

Date: March 12, 2026

Attention: All Providers

Effective date: April 1, 2026

Call to action: Effective for dates of service on or after April 1, 2026, Texas Medicaid will update the prior authorization requirements for onasemnogene abeparvovec-xioi (Zolgensma) (procedure code J3399).

Authorization Requirements

Prior authorization requests must include the patient’s baseline platelet counts. The provider must assess the patient’s safety by continually checking weekly counts for the first month and then every other week for the second and third months until platelet counts return to baseline.

Providers must document results from the post-monitoring requirements (liver function tests and platelet counts) in the patient’s medical record. These records are subject to retrospective review.

Providers can refer to the current Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, subsection 6.93.2, “Documentation Requirements,” for additional prior authorization requirements for onasemnogene abeparvovec-xioi (Zolgensma).

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: www.texaschildrenshealthplan.org/provideralerts.