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New prior authorization requirements for Burosumab-Twza(Crysvita)
Attention: Nephrologists and Endocrinologists
Effective Date: 1/6/2021
Call to action: Texas Children’s Health Plan (TCHP) is aligning prior authorization criteria for burosumab-twza (Crysvita), J0584, with the Texas Medicaid Provider Procedures Manual (TMPPM). Crysvita is a clinician administered drug indicated for members with X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia. Below are the new prior authorization criteria for TCHP members effective 01/06/2021. For initial therapy, the following criteria must be met:
The client has a diagnosis of X-linked hypophosphatemia (XLH) (diagnosis code E8330 or E8331) that is supported by one of the following:
Confirmed phosphate regulating gene with homology to endopeptidases located on the X chromosome (PHEX-gene) mutation
The prescriber discontinues any oral phosphate or active vitamin D analog supplementation at least one week prior to starting burosumab-twza (Crysvita) therapy.
The prescriber agrees to measure serum phosphate throughout therapy and withhold medication when serum phosphorus is above 5 mg/dl.
OR
The client has a diagnosis of fibroblast growth factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors that cannot be localized or are not amenable to surgical excision.
The client is two years of age or older.
The prescriber discontinues any oral phosphate or vitamin D analog supplement at least two weeks prior to starting burosumab-twza (Crysvita) therapy.
The prescriber agrees to measure serum phosphate throughout therapy.
For both indications:
For renewal or continuation of therapy, the following criteria must be met:
Previous treatment of Burosumab-twza (Crysvita)
Provider continues to monitor serum phosphate level
Documentation from the provider that:
Patient has achieved normal levels of phosphate OR
Patient has demonstrated positive clinical response to Burosumab-twza (Crysvita) (e.g., enhanced height velocity, improvement in askeletal deformity, reduction of fractures, and reduction of generalized bone pain)
How this impacts providers: Prescribers should adjust their prescribing patterns accordingly and communicate these changes to their staff.
Next steps for providers: Providers should communicate these changes to their staff.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
