Date: November 10, 2026
Attention: All Providers
Effective date: November 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 November 1, 2026, prior authorization requirements will change for the treatment of polyneuropathy of hereditary transthyretin-mediated amyloidosis (hATTR).
Requests for Initial Therapy
Prior Authorization Required for Eplontersen (Wainua)
Prior authorization will be required for eplontersen (Wainua) (procedure code C9311), which is an antisense oligonucleotide.
Providers must submit prior authorization requests for eplontersen (Wainua) on the Special Medical Prior Authorization (SMPA) Request Form. Prior authorization requests may be approved for one 12-month duration per request.
Texas Medicaid may approve initial injection therapy for eplontersen (Wainua) if all the following criteria are met:
- The patient is 18 years of age or older.
- The patient has a diagnosis of hATTR (diagnosis code E851), supported by the following:
- A transthyretin (TTR) mutation proven by genetic testing
- Clinical signs and symptoms of the disease (e.g., peripheral/autonomic neuropathy, motor disability)
- The patient will not receive eplontersen (Wainua) therapy in combination with other polyneuropathy hATTR therapies (e.g., inotersen, patisiran, vutrisiran, or tafamidis meglumine).
- The patient will receive vitamin A supplementation at the recommended daily allowance while on eplontersen (Wainua) therapy.
Updated Criteria for Patisiran (Onpattro) and Vutrisiran (Amvuttra)
Texas Medicaid will update the following prior authorization requirement for patisiran (Onpattro) to include eplontersen:
- The patient will not receive patisiran (Onpattro) therapy in combination with other polyneuropathy hATTR therapies (e.g., eplontersen, inotersen, tafamidis meglumine, or vutrisiran).
Texas Medicaid will update the following prior authorization requirement for vutrisiran (Amvuttra) to include eplontersen:
- The patient will not receive vutrisiran (Amvuttra) therapy in combination with other polyneuropathy hATTR therapies (e.g., eplontersen, inotersen, tafamidis meglumine, or patisiran).
Requests for Renewal or Continuation of Therapy
For renewal or continuation of therapy with eplontersen (Wainua), patisiran (Onpattro), or vutrisiran (Amvuttra) injection, the patient must meet the following requirements:
- The patient has previously received treatment with eplontersen (Wainua), patisiran (Onpattro), or vutrisiran (Amvuttra) without an adverse reaction.
- The patient has a positive clinical response to eplontersen (Wainua), patisiran (Onpattro), or vutrisiran (Amvuttra) (e.g., improved neurologic impairment, improved motor function, or 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.
