MedicaidPrior AuthMedium impact
Provider Letter 2025-23: RE: Prior Authorization of Photrexa®/Photrexa® Viscous Cross-Linking Kit - Effective January 1, 2026
Oklahoma SoonerCare·OK · Ophthalmology, Optometry·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Starting January 1, 2026, Oklahoma Medicaid will require prior authorization for Photrexa/Photrexa Viscous Cross-Linking Kit used to treat progressive keratoconus and corneal ectasia. The medication must be prescribed by trained optometrists or ophthalmologists and used with specific procedures and equipment.
Action Required
By January 1, 2026: Billing team must update system to flag Photrexa/Photrexa Viscous Cross-Linking Kit for prior authorization requirement for Oklahoma Medicaid patients. Optometry and ophthalmology providers must submit Form PHARM-18 to Pharmacy Prior Authorization Unit via fax before prescribing. Ensure documentation includes FDA-approved diagnosis of progressive keratoconus or corneal ectasia, provider training certification, and confirmation of epithelial-off procedure with KXL System. Claims will be denied without prior authorization.