MedicaidCoverageMedium impact
Age Restriction to be Updated in the TMPPM for Hympavzi (Marstacimab-hncq)
Texas Medicaid·TX · Pediatrics, Hematology·General
Effective date
Oct 1, 2026
We identified it
Aug 20, 2026
Summary
Texas Medicaid is expanding eligibility for Hympavzi (Marstacimab-hncq) by lowering the minimum age requirement from 12 years to 6 years of age, effective October 1, 2026. This aligns the state policy with FDA labeling and allows younger pediatric patients to access this drug under Texas Medicaid coverage.
Action Required
By September 30, 2026: Billing team must update all billing system rules, eligibility verification systems, and clinical documentation templates to recognize Hympavzi (J7172) as eligible for patients aged 6 years and older (previously 12 years and older). Update any internal age-restriction edits in the billing system to reflect the new 6-year minimum. Verify with patient's specific Texas Medicaid MCO regarding their implementation timeline and prior authorization requirements, as MCO procedures may vary. Document the change in policy tracking. Failure to update age restrictions may result in claim denials for eligible pediatric patients ages 6-11.