Texas Medicaid Prior Authorization Update for Clofarabine

Date: December 5, 2025

Attention: Providers

Effective date: January 1, 2026

Call to action: The purpose of this communication if to inform providers that Texas Medicaid will update the prior authorization criteria for clofarabine (procedure code J9027), effective for dates of service on or after January 1, 2026. (Medical Benefit)

UPDATE: Texas Medicaid may approve prior authorization of clofarabine only for clients who are 1 through 21 years of age.

Next step for Providers: Providers can refer to the current Texas Medicaid Provider Procedures Manual, Outpatient Drug Services Handbook, subsection 6.31.1, “Prior Authorization for Clofarabine,” for additional prior authorization criteria.

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org. 

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.