Effective July 1, 2025: Prior Authorization Now Required for Niktimvo (Axatilimab-csfr)
Effective July 1, 2025, prior authorization will be required when healthcare providers in Texas want to prescribe axatilimab-csfr (Niktimvo) to Medicaid patients as well. Niktimvo is an IV drug that treats individuals with chronic graft-versus-host disease (cGVHD), a disease that may develop following a stem cell transplant.
Patients will have to fulfill a number of conditions in order to secure the approval of this drug. They are required to weigh at least 88 pounds and must have a diagnosed cGVHD in a particular medical code (D89811 or D89812). The patient should have received an allogenic stem cell transplant and failed to respond to two other treatments. Also, physicians should ensure that they have discussed birth control with any female patient who is capable of becoming pregnant because one should not get pregnant during the treatment or 30 days after treatment.
The same holds in the case of patients who are already taking Niktimvo and require further therapy. The patient should also be doing well on the drug without having severe side effects and demonstrate an improvement.
Doctors are also expected to keep a close watch on the patients. The liver enzymes and other blood markers such as AST, ALT, ALP, CPK, amylase, and lipase should be tested prior to treatment, after every two weeks in the first month, and a month or two following completion of treatment.
