TX Medicaid Golodirsen (Vyondys 53®)

Texas Medicaid covers antisense oligonucleotides (eteplirsen, golodirsen, nusinersen, viltolarsen) and will reimburse injectable antibiotics/steroids (but denies steroid injections for chronic conditions and forbids concomitant exon‑skipping therapies); physician administration services do not require prior authorization. Antisense therapies require prior authorization via the SMPA form with genetic confirmation of exon/SMN1 eligibility, baseline age‑appropriate functional testing, a neurologist consult within 6 months, specified weight/renal/pulmonary monitoring, initial approvals for six months with six‑month recertification, use of modifier KX when injections replace oral meds (and AT for acute steroid injections), and treatment must be stopped if physical (or pulmonary for nusinersen) function declines.

"Physician services associated with administration of eteplirsen, golodirsen, nusinersen, or viltolarsen do not require prior authorization (procedural costs and associated supplies)."