All PlansPrior AuthMedium impact
Medical Injectable Drug Crysvita to Require Prior Authorization
Highmark·DE, PA, WV, NY · Endocrinology, Pediatrics, Nephrology·Pharmacy
Effective date
Jul 15, 2026
We identified it
May 14, 2026
Summary
Crysvita (burosumab-twza), a medical injectable drug billed under HCPCS code J0584, will require prior authorization for all lines of business. The requirement takes effect July 15, 2026 for Delaware, Pennsylvania, and West Virginia, and August 15, 2026 for New York.
Action Required
By July 15, 2026 (DE, PA, WV) and August 15, 2026 (NY): Billing team must update system to require prior authorization for HCPCS code J0584 (Crysvita/burosumab-twza). Update encounter forms and EMR templates to alert providers that prior auth is required before administration. Verify current medical policy coverage criteria on Highmark's Provider Resource Center. Claims will be denied without prior authorization.