Texas MedicaidMedium ImpactPrior Auth
Texas Medicaid Prior Authorization Update for Onasemnogene Abeparvovec-xioi (Zolgensma) Effective April 1, 2026
Published March 7, 2026Effective April 1, 2026
AI Summary
Starting April 1, 2026, Texas Medicaid will require baseline platelet counts in prior authorization requests for Zolgensma (J3399) and mandate specific monitoring schedules. Providers must document weekly platelet counts for the first month, then every other week for months 2-3, with all results subject to retrospective review.
Action Required
Before April 1, 2026: Update prior authorization request templates to include baseline platelet counts for Zolgensma (J3399). Establish monitoring protocols for weekly platelet counts (month 1) and bi-weekly counts (months 2-3). Ensure documentation of all platelet counts and liver function tests in patient medical records as these are subject to retrospective review by Texas Medicaid.
Affected Billing Codes
J3399
Plan Types
Medicaid
States
TX
Specialties
neurology, pediatrics