Prior Authorization Criteria for Prademagene Zamikeracel (Zevaskyn) Effective May 1, 2026
AI Summary
Effective May 1, 2026, Texas Medicaid will require prior authorization for prademagene zamikeracel (Zevaskyn), a gene therapy for treating wounds in patients with recessive dystrophic epidermolysis bullosa. Providers must use the Special Medical Prior Authorization (SMPA) Request Form and meet specific clinical criteria including patient age 6+, confirmed RDEB diagnosis, and qualifying chronic wounds.
Action Required
By May 1, 2026: Billing team must update system to require prior authorization for HCPCS code J3389 (prademagene zamikeracel) for Texas Medicaid patients. Providers must obtain approval using Special Medical Prior Authorization (SMPA) Request Form before administering this gene therapy. Contact TMHP at 800-925-9126 for questions. Claims will be denied without prior authorization.
Affected Billing Codes
Plan Types
Medicaid
States
TX
Specialties
dermatology, wound-care, pediatrics