HHSC requires prior authorization for Emflaza (deflazacort). Deflazacort is FDA-approved for the treatment of Duchenne muscular dystrophy (DMD) in clients two years of age and older. Prescribing providers complete and submit the Emflaza Standard Prior Authorization Addendum (HHS Form 1347).
Treatment approval criteria for Emflaza include the following:
- Clients two years of age and older with a diagnosis DMD.
- The client has tried prednisone for three months or longer and has one the following adverse events as a result prednisone use:
- Cushingoid appearance;
- Central (truncal) obesity;
- Undesirable weight gain (greater than or equal to 10% body weight gain over a six-month period);
- Diabetes and/or hypertension that is difficult to manage; or
- Experienced a severe behavioral adverse event.
For renewal requests, prescribing providers should complete sections 1, 5 and 6 of the form.
Reasons for denial include but are not limited to the following:
- Age less than two years
- Use of CYP3A4 in last 90 days
- No previous trial with prednisone