Prior Authorization for Decnupaz

Call to action: Texas Children's Health Plan (TCHP) would like to inform providers that the Texas Health and Human Services Commission (HHSC) is adding Decnupaz (procedure code C9313) as a Medicaid and CHIP benefit beginning on October 1, 2026, and will require prior authorization for these programs effective November 1, 2026.

Decnupaz (pivekimab sunirine-pvzy) is a CD 123-directed antibody and alkylating agent conjugate indicated for the treatment of blastic plasmacytoid dendritic cell neoplasm (BPDCN) in adult patients 18 years and older.

Authorization requirements

• HHSC requires prior authorization for Decnupaz (pivekimab sunirine-pvzy).
• Prior authorization requests for Decnupaz infusion will be approved for a duration of 12 months for patients who meet the following requirements:

1. For initial therapy
   1. Patient has a diagnosis of blastic plasmacytoid dendritic cell neoplasm (diagnosis code C86.4) excluding acute promyelocytic leukemia (APL, FAB, M3)
   2. Patient is 18 years or older
   3. Patient has a CD-123 positive/expressing disease
   4. Patient has adequate baseline hepatic function and liver function test, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin are within normal limits.
   5. Decnupaz may cause hepatotoxicity, including veno-occlusive disease (VOD), a severe form of hepatotoxicity. Therefore, the patient’s hepatic function must be monitored prior to each course of therapy to mitigate the risk of severe or fatal VOD. Therapy should be delayed with liver test elevations and permanently discontinued in patients who experience VOD.
   6. Prescriber attests to closely monitor for signs and symptoms of VOD including elevations in liver tests, hepatomegaly, rapid weight gain, and ascites.
2. For renewal or continuation of therapy, the patient must meet all the following criteria:
   1. Patient continues to meet initial approval criteria
   2. Patient has previously received treatment with pivekimab sunirine-pvzy with absence of adverse drug reactions or drug toxicity.
   3. Patient has a positive clinical response demonstrated by disease stabilization.

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.