Updated Prior Authorization Criteria for Benralizumab (Fasenra)

Date: September 30, 2026

Attention: All Providers

Effective date: October 1, 2026

Call to action: Texas Children's Health Plan (TCHP) would like to inform providers that effective for dates of service on or after October 1, 2026, Texas Medicaid will update the prior authorization criteria for benralizumab (Fasenra).

The U.S. Food & Drug Administration (FDA) has approved benralizumab (Fasenra) (procedure code J0517) as a treatment for adult and pediatric patients who are 12 years of age or older with hypereosinophilic syndrome (HES) without an identifiable non-hematologic secondary cause.

Prior Authorization Requirements

The Texas Medicaid & Healthcare Partnership (TMHP) will consider prior authorization requests for benralizumab (Fasenra) for HES if the patient meets the following criteria:

• The patient is 12 years of age or older.
• The patient has a diagnosis of HES without identifiable non-hematologic secondary cause (diagnosis code D72110, D72111, D72118, or D72119).
• Documentation supporting medical necessity for treatment of benralizumab (Fasenra) must be submitted with the prior authorization request and meet the following criteria:
  • The patient has a diagnosis of HES or exhibits signs and symptoms of HES without any non-hematologic secondary cause.
  • The patient has a history of two or more HES flares within the past 12 months before the start of benralizumab (Fasenra) therapy. A flare is defined as worsening clinical symptoms or blood eosinophil counts requiring an increase in prior therapy.
  • The prescribing provider attests that the patient has been on a stable dose of HES therapy which includes, but is not limited to, oral corticosteroids, immunosuppressives, and cytotoxic therapy.

Next step for providers: Providers should share this information 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.