The following medical drug policies are new and require precertification:
- Inebilizumab-cdon (Uplizna)
- Pertuzumab, trastuzumab, and hyaluronidase-zzxf (Phesgo)
- Tafasitamab-cxix (Monjuvi)
The following medical drug policies were revised and require precertification:
The following medical drug policies are new:
- Hydroxyprogesterone Caproate Injection as a Technique to Reduce Preterm Birth in High-Risk Pregnancies
- Intravenous Anesthetics for Off-Label Indications
- Viltolarsen (Viltepso)
The following medical drug policies were revised:
- Belimumab (Benlysta)
- Bevacizumab (Avastin) and Bevacizumab Biosimilars
- Chemodenervation with Botulinum Toxin
- Chimeric Antigen Receptor Therapy for Hematologic Malignancies
- Copanlisib (Aliqopa)
- Daunorubicin and Cytarabine Liposomal (Vyxeos)
- Granulocyte Colony-Stimulating Factors
- Immune Globulin Therapy
- Infliximab
- Intravitreal Implants
- Luspatercept (Reblozyl)
- Mogamulizumab-kpkc (Poteligeo)
- Olaratumab (Lartruvo)
- Polatuzumab vedotin-piiq (Polivy)
- Rituximab (Rituxan), Rituximab Biosimilars, and Rituximab and Hyaluronidase Human (Rituxan Hycela)
- Romiplostim (Nplate)
- Tocilizumab (Actemra)
- Trastuzumab (Herceptin), Trastuzumab Biosimilars, and Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
- Treatment of Gaucher Disease
- Ustekinumab (Stelara)
- Vestronidase Alfa-vjbk (Mepsevii)
The following medical drug policies were reviewed with no clinical content change:
- Bezlotoxumab (Zinplava)
- Laronidase (Aldurazyme)
- Necitumumab (Portrazza)
- Pegloticase (Krystexxa)
- Treatment of Hereditary Angioedema (HAE)
The following medical drug policies had coding changes effective 10/1/2020:
- Abatacept (Orencia)
- Brexanolone (Zulresso)
- Certolizumab (Cimzia)
- Crizanlizumab-tmca (Adakveo)
- Daratumumab (Darzalex) and Daratumumab and Hyaluronidase-fihj (Darzalex Faspro)
- Eptinezumab-jjmr (Vyepti)
- Golimumab (Simponi Aria)
- Immune Prophylaxis for Respiratory Syncytial Virus (RSV)
- Isatuximab-irfc (Sarclisa)
- Monoclonal Antibodies for the Treatment of Eosinophilic Conditions
- Oncologic Indications for Histone Deacetylase (HDAC) Inhibitors
- Romosozumab-aqqg (Evenity)
- Sacituzumab govitecan-hziy (Trodelvy)
- Teprotumumab-trbw (Tepezza)