Immunosuppressive Drug Indications and Age Limitations to Be Updated for Texas Medicaid

Date: November 25, 2025

Attention: All Providers

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after December 1, 2025, age limitations and treatment indications will be added for some immunosuppressive drugs.

Age Limitations

Texas Medicaid will limit coverage for the following immunosuppressive drugs to clients who are 18 years of age or older:

• Alemtuzumab injection (procedure code J0202)
• Alpha-1 proteinase inhibitor (procedure code J0257)
• Belatacept injection (procedure code J0485)
• Glatiramer acetate injection (procedure code J1595)

Texas Medicaid will limit coverage for the following immunosuppressive drugs to clients who are 2 years of age or older:

• Certolizumab pegol injection (procedure code J0717)
• Golimumab injection (procedure code J1602)

Texas Medicaid will have no age restriction for the treatment of rheumatoid arthritis with azathioprine (procedure code J7501).

Treatment Indications

On December 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, “Immunosuppressive Drugs,” to include additional indications for the following immunosuppressive drug procedure codes:

• Certolizumab pegol injection (procedure code J0717): Treatment of rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, non-radiographic axial spondylarthritis, and plaque psoriasis
• Golimumab injection (procedure code J1602): Treatment of polyarticular juvenile idiopathic arthritis

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.