Update to Initial Prior Authorization Criteria for Beremagene Geperpavec-svdt (Vyjuvek)

Date: August 21, 2024 

Attention: All Providers

Effective date: September 1, 2024 

Call to action: Texas Children’s Health Plan (TCHP) would like to inform network providers that effective for dates of service on or after September 1, 2024, initial prior authorization criteria will be updated for beremagene geperpavec-svdt (Vyjuvek),procedure code J3401. 

The initial criteria for female patients of childbearing age will updated as follows:

• The prescribing physician attests to counseling female clients of childbearing age regarding the use of an effective method of contraception to prevent pregnancy during treatment with beremagene geperpavec-svdt (Vyjuvek).

How this impacts providers: Claims that were submitted with dates of service on or after January 1, 2024, for drug wastage for procedure code J3401 will be reprocessed. Providers may receive additional payment when the claims are reprocessed. 

Next step for providers: Providers should share this update with their staff. Providers are encouraged to submit authorization requests on Texas Children’s® Link since this is the most efficient way for our team to process authorizations. If providers are experiencing any barriers to submitting prior authorizations on the portal, they are encouraged to reach out to their assigned Provider Relations Liaison (PRL).

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

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.