ND Committee Review
Internal Medical Policy Committee 1-19-2021 Adopt policy, was previously policy number I-37
Internal Medical Policy Committee 3-17-2021 Updated criteria for CD and UC
Internal Medical Policy Committee 3-23-2022
- Removed
sulfasalazine from CD conventional agents;
and
- Removed
steroid suppositories from UC conventional agents;
and
- Added
Zeposia as a contraindicated drug;
and
- Added
list of agents contraindicated as concomitant therapy
Internal Medical Policy Committee 11-29-2022 -
Effective January 01, 2023
- Updated
combination therapy criteria,
and
- Removed
latent tuberculosis criteria from the policy,
and
- Removed
FDA labeled contraindications criteria from the policy,
and
- Updated
Agents NOT to be used Concomitantly list,
and
- Updated
experimental/investigational statement,
and
- Updated
diagnosis code list
Internal Medical Policy Committee 11-15-2023
Effective January 01, 2024
- Added
Other criteria
- Updated
Agents NOT to be used Concomitantly list
Internal Medical Policy Committee 5-14-2024
Effective July 01, 2024
- Added
new code, Q5138 for ustekinumab-auub (Wezlana) intravenous to the policy
- Updated
policy title to remove 'Stelara'
Internal Medical Policy Committee 11-19-2024
Effective December 08, 2024