Aducanumab-avwa (Aduhelm™) - TX Medicaid

Texas Medicaid covers aducanumab‑avwa (Aduhelm; J0172) only for confirmed Alzheimer's disease (ICD‑10 G300, G301, G308, G309) limited to mild cognitive impairment or mild Alzheimer's and excludes moderate/severe dementia and patients on anticoagulants (except prophylactic‑dose aspirin) or with clotting disorders; dual‑eligibles must follow the Medicare NCD. Coverage requires prior authorization (initial 6‑month approval), documentation of amyloid pathology and exclusion of other dementias, baseline and serial brain MRIs (including before the 5th, 7th, 9th and 12th infusions) with ARIA monitoring during the first eight doses, and demonstration of radiographic/clinical benefit and absence of unacceptable toxicity for continuation.

"Procedure code J0172 limited to diagnosis codes G300, G301, G308, or G309 (confirmed diagnosis of Alzheimer's disease)."

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