MedicaidPrior AuthMedium impact
Texas Medicaid Prior Authorization Update for Onasemnogene Abeparvovec-xioi (Zolgensma) Effective April 1, 2026
Texas Medicaid·TX · Neurology, Pediatrics·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Mar 7, 2026
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.