Prior Authorization Required for Exdensur

Date: August 3, 2026

Attention: All Providers

Effective date: September 1, 2026

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 1, 2026, prior authorization will be required for depemokimab-ulaa (Exdensur) (procedure code J2361).

Depemokimab-ulaa (Exdensur) is a subcutaneous injection that is approved by the U.S. Food & Drug Administration (FDA) for treatment of patients who are 12 years of age or older. It’s indicated as an add-on maintenance treatment for severe asthma that is characterized by an eosinophilic phenotype.

Prior Authorization Requirements

Providers must submit prior authorization requests for depemokimab-ulaa (Exdensur) on a Special Medical Prior Authorization (SMPA) Request Form.

Prior authorization for depemokimab-ulaa (Exdensur) may be approved for a period of 12 months for patients who meet the following requirements:

• The patient is 12 years of age or older.
• The patient has a confirmed diagnosis of severe asthma (as defined by the National Heart, Lung, and Blood Institute’s Guidelines for the diagnosis and management of asthma) (diagnosis code J4550, J4551, or J8283).
• The patient’s asthma is characterized by an eosinophilic phenotype with a baseline blood eosinophilic count of at least 150 cells/microliter or greater.
• The patient has asthma that is uncontrolled before administration of depemokimab-ulaa (Exdensur) as an add-on treatment.
• The patient has adhered to at least three consecutive months of inhaled corticosteroid therapy and used at least one additional asthma controller or asthma maintenance medication.
• The patient’s asthma is inadequately controlled despite the use of controller therapy, i.e., medium- to high-dose inhaled corticosteroid (ICS) plus at least one asthma controller with or without maintenance oral corticosteroids (OCS), indicated by either of the following within the previous year:
  • At least two or more asthma exacerbations that required treatment with systemic corticosteroids (SCS)
  • Reduced lung function with forced expiratory volume in one second (FEVI) that was less than 80% of predicted
• Depemokimab-ulaa (Exdensur) will be used as an add-on maintenance therapy to the patient’s medication for asthma and may not be used as a single or primary therapy.
• Depemokimab-ulaa (Exdensur) will not be used in combination with anti-IgE, anti-IL4, or anti-IL5 monoclonal antibody agents (such as omalizumab, benralizumab, mepolizumab, or reslizumab).

Reimbursement

Providers may not submit claims for the reimbursement of procedure code J2361 and procedure code J0517, J2182, J2356, or J2786 with the same date of service by any provider.

Providers may not submit a claim for the reimbursement of an office visit if the only reason for the visit is an omalizumab, benralizumab, mepolizumab, reslizumab, or tezepelumab-ekko injection.

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.