MedicaidPrior AuthMedium impact
2025.63 - Removal of PA Requirement for Adbry - Dupixent - Fasenra & Xolair - DX Requirement for Adbry - Dupixent - Ebglyss - Fasenra - Tezspire & Xolair
Connecticut Medicaid (HUSKY Health)·CT · Allergy & Immunology, Dermatology, Pulmonology +1 more·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY A, B, C, D) is removing prior authorization requirements for Adbry, Dupixent, Fasenra, and Xolair effective January 1, 2026. However, these medications plus Ebglyss and Tezspire will now require specific ICD-10 diagnosis codes on prescriptions and pharmacy claims, with reimbursement limited to FDA-approved indications only.
Action Required
Before January 1, 2026: Billing team must update pharmacy billing systems to remove prior authorization requirements for Adbry, Dupixent, Fasenra, and Xolair for Connecticut Medicaid patients. Simultaneously, configure systems to require appropriate ICD-10 diagnosis codes for Adbry, Dupixent, Ebglyss, Fasenra, Tezspire, and Xolair claims. Review the ICD-10-CM Therapeutic Class Product Diagnosis List at www.ctdssmap.com to identify payable diagnosis codes. Providers must ensure prescriptions include appropriate ICD-10 codes matching FDA-approved indications. Claims without proper diagnosis codes or for off-label uses will be denied.