Updated Prior Authorization Criteria for Elevidys

Date: October 8, 2026

Attention: All Providers

Effective date: November 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 November 1, 2026, Texas Medicaid will update the prior authorization criteria for delandistrogene moxeparvovec‐rokl (Elevidys). This follows the changes to the medication label that the U.S. Food & Drug Administration (FDA) recently made about how to use delandistrogene moxeparvovec‐rokl (Elevidys) (procedure code J1413) safely and effectively.

Updated Prior Authorization Requirement

Delandistrogene moxeparvovec‐rokl (Elevidys) is a one-time intravenous infusion therapy indicated for the treatment of patients with Duchenne muscular dystrophy who are 4 years of age and older and ambulatory.

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.