Prior Authorization Update for Amvuttra (J0225) Effective February 1, 2023 

December 19, 2022

What’s new

Effective February 1, 2023, Texas Health and Human Services Commission (HHSC) approved Amvuttra (J0225) for clinical prior authorization use and implementation of the criteria for fee-for-services.  Blue Cross and Blue Shield of Texas (BCBSTX) does not have to wait for the publication in the Texas Medicaid Providers Policy Manual (TMPPM) before implementation. 

Authorizations Requirements:

The approval duration is 12 months for procedure code J0225, Amvuttra.  

Initial Requests

Prior authorization approval for Amvuttra injection will be considered once the following criteria are met:

For initial therapy-

  • Client is 18 years of age or older
  • Diagnosis of hereditary transthyretin (hATTR) amyloidosis (diagnosis code: E85.1), supported by

1. Transthyretin (TTR) mutation proven by genetic testing

2. Clinical signs and symptoms of the disease (e.g., peripheral/autonomic neuropathy, Motor disability.

  • Client will not receive Amvuttra (vutrisiran) therapy in combination with other polyneuropathy hATTR amyloidosis therapies (e.g., inotersen, tafamidis meglumine or patisiran).
  • Client will receive vitamin A supplementation at the recommended daily allowance while on Ambuttra (vutrisiran) therapy.
  • Client has not had a liver transplant.

Renewal or Continuation Therapy

For renewal or continuation therapy, the client must meet all the following requirements:

  • Client has previously received treatment with Amvuttra (vutrisiran) without an adverse reaction.
  • Client has a positive clinical response to Amvuttra (e.g., improved neurologic impairment, improved motor function, slowing of disease progression).


Refer to the Outpatient Drug Services Handbook Chapter of the Texas Medicaid Provider Procedure Manual (TMPPM) for more details on the clinical policy and prior authorization requirements.


For questions or additional information, please:

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.