Age Restriction Updates for Evkeeza and Ajovy for Texas Medicaid and the CSHCN Services Program

Date: December 5, 2025

Attention: All Providers

Effective date: December 1, 2025

Call to action: Texas Children’s Health Plan (TCHP) informs providers that effective for dates of service on or after December 1, 2025:

• Evinacumab-dgnb (Evkeeza) (procedure code J1305) will be a benefit for only Texas Medicaid clients who are 1 year of age or older.
• Fremanezumab-vfrm (Ajovy) (procedure code J3031) will be a benefit for Texas Medicaid and Children with Special Health Care Needs (CSHCN) Services Program clients who are 6 years of age or older.

On December 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM), Outpatient Drug Services Handbook, sections 6.6, “Ajovy (Fremanezumab-vfrm),” and 6.51, “Evinacumab-dgnb (Evkeeza).”

Next steps: Providers should 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: www.texaschildrenshealthplan.org/provideralerts.