Internal Medical Policy Committee 1-14-2019 Adopted policy
Internal Medical Policy Committee 1-22-2020 Annual review, no clinical changes,
- belinostat (Beleodaq) - J9032,
- romidepsin (Istodax) - will require pre-certification as of 2/1/2020
Internal Medical Policy Committee 7-22-2020 Revision
- Added additional NCCN recommendations for belinostat (Beleodaq) and romidepsin (Istodax),
- Updated formatting, diagnosis codes and references
Internal Medical Policy Committee 9-21-2020 Coding update
- Added new code, C9065, to policy
Internal Medical Policy Committee 9-21-2021 Coding update
- Added new codes J9318 and J9319 to the policy, and
- Removed C9065 and J9315, and
- Added Diagnosis code C84.7A
Internal Medical Policy Committee 9-28-2022 Annual review - no change in criteria
Internal Medical Policy Committee 1-26-2023 Effective March 01, 2023
- Removed NCCN recommendations and added this statement ' Drug may be considered medically necessary for treatment of any of the current category 1 or 2A NCCN recommendations.'
- Removed diagnosis code Z85.72 from J9032 and J9318/J9319
- Updated experimental/investigational statement
Internal Medical Policy Committee 1-16-2024 Effective March 01, 2024
- Annual review no clinical content change