Traditional Medicaid

HHSC requires prior authorization for Emflaza (deflazacort). Deflazacort is FDA-approved for the treatment of Duchenne muscular dystrophy (DMD) in clients 2 years 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 2 years 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:

• Less than 2 years old
• Use of CYP3A4 in last 90 days
• No previous trial with prednisone