Prior Authorization for Wainua

Date: September 30, 2026

Attention: All Providers

Effective date: November 1, 2026

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 Wainua (procedure code C9311) as a Medicaid and CHIP benefit beginning on on October 1, 2026, and will require prior authorization for these programs effective November 1, 2026.

Wainua (eplontersen) is an antisense oligonucleotide indicated for the treatment of the polyneuropathy of hereditary transthyretin-mediated (hATTR) amyloidosis in adults.

• HHSC requires prior authorization for Wainua (eplontersen).
• Prior authorization requests for Wainua infusion will be approved for a duration of 12 months for patients who meet the following requirements:
  • For initial therapy:
    • Patient is 18 years or older
    • Diagnosis of hereditary transthyretin (hATTR) amyloidosis (diagnosis code: E85.1), supported by:
      • Transthyretin (TTR) mutation proven by genetic testing
      • Clinical signs and symptoms of the disease (e.g., peripheral/autonomic neuropathy, motor disability)
    • Patient will not receive Wainua therapy in combination with other polyneuropathy hATTR amyloidosis therapies (e.g., inotersen, patisiran, vutrisiran, or tafamidis meglumine)
    • Patient has not had a liver transplant.
  • For renewal or continuation of therapy, the patient must meet all the following criteria:
    • Patient has previously received treatment with Wainua without an adverse reaction.
    • Patient has a positive clinical response to Wainua (e.g., improved neurologic impairment, improved motor function, slowing of disease progression)

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.