Clinical Criteria Revision for Evkeeza® effective June 1, 2023

Date: May 18, 2023

Attention: All Providers

Effective Date: June 1, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective June 1, 2023, Texas Health and Human Services (HHSC) will expand coverage for Evkeeza^® (procedure code J1305) to adolescents 5 years of age and older due to a recent U.S. Food and Drug Administration (FDA) approval. Evkeeza^® is an injectable prescription medicine used along with other low-density lipoprotein (LDL) lowering medicines in treating high cholesterol called homozygous familial hypercholesterolemia (HoFH).

How this impacts providers: Starting June 1, 2023, TCHP will expand the age requirement to adolescents 5 years of age and older. Refer to the Outpatient Drug Services Handbook Chapter of the Texas Medicaid Provider Procedure Manual for more details on the clinical policy and prior authorization requirements.

Next steps for providers: Prescribers should share this communication with their staff. It is important for providers to be aware of this new age indication. Providers will need to consider the dosage and administration for the younger population and monitor for any potential adverse effects. Providers must submit documentation (such as office chart notes, lab results, other pertinent clinical information, etc.) supporting that the member has met all appropriate criteria in support for Evkeeza^® approval.

If you have any questions, please email TCHP Pharmacy at: tchppharmacy@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.