Removal of Certain Drugs from the TMPPM

Date: May 23, 2025

Attention: All Providers

Effective Date: June 1, 2025

Call to action: The purpose of this communication is to inform providers that on June 1, 2025, Texas Medicaid & Healthcare Partnership (TMHP) will remove the following subsections from the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook:

• Subsection 6.18, “Brexanolone (Zulresso)” – procedure code J1632 will no longer have a rebate-eligible National Drug Code (NDC), effective June 1, 2025.
• Subsection 6.77, “Lefamulin (Xenleta)” – procedure code J0691 currently does not have a rebate-eligible NDC.
• Subsection 6.91, “Moxetumomab Pasudotox-tdfk (Lumoxiti)” – procedure code J9313 will no longer have a rebate-eligible NDC, effective June 1, 2025.

These drugs are not covered on the Texas Medicaid benefit.

Next steps: Providers are encouraged to share this communication with their staff.

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

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