MedicaidPrior AuthMedium impact
2026.47 - Provider Bulletin - Familial Chylomicronemia Syndrome (FCS) Agents Redemplo and Tryngolza
Connecticut Medicaid (HUSKY Health)·CT · Pharmacy, Endocrinology, Internal Medicine·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Sep 5, 2026
Summary
Connecticut DSS is implementing new clinical criteria and Prior Authorization (PA) requirements for two Familial Chylomicronemia Syndrome (FCS) agents: Redemplo and Tryngolza, effective October 1, 2026. All pharmacy claims for these drugs under HUSKY A, HUSKY C, HUSKY D, and Emergency Medicaid Dialysis Services will require PA submission, with claims denied if any PA criteria questions are answered NO.
Action Required
By October 1, 2026: Billing team and pharmacy staff must implement prior authorization workflow for Redemplo and Tryngolza claims. (1) Access and review the clinical criteria and PA forms posted at www.ctdssmap.com under Pharmacy Information → Pharmacy Prior Authorization Program. (2) Update billing system to flag all Redemplo and Tryngolza prescriptions for HUSKY A, HUSKY C, HUSKY D, and EMDS clients as requiring PA before claim submission. (3) Train pharmacy and billing staff on the new PA submission process, including referencing PB 2025-40 for submission procedures. (4) Ensure all PA requests include complete clinical documentation; claims will be denied if any criteria question is answered NO. (5) Contact Provider Assistance Center at 1-800-842-8440 (Mon–Fri, 8am–5pm) with questions. Failure to obtain prior authorization before claim submission will result in claim denials.