Medical drug program updates
You can refer to the chart below to review changes and updates related to CarePartners of Connecticut's prior authorization and coverage program for medical drugs.
Medications being added to prior authorization | ||
Drug(s) and Policy | Effective date | Additional information |
PiaSky | 1/1/2025 | Prior authorization is now required PiaSky (HCPCS J1307), approved by the FDA in June 2024 for the treatment of adult and pediatric patients 13 years and older with paroxysmal nocturnal hemoglobinuria and body weight of at least 40 kg. |
1/1/2025 | Prior authorization is now required for Kisunla (HCPCS J0175), approved by the FDA in July 2024 for the treatment of Alzheimer’s disease. | |
1/1/2025 | Prior authorization is now required for Rytelo (HCPCS C9399, J3490), approved by the FDA in April 2024 for the treatment of adult patients with low- to intermediate-1 risk myelodysplastic syndromes with transfusion-dependent anemia requiring 4 or more red blood cell units over 8 weeks who have not responded to or have lost response to or are ineligible for erythropoiesis-stimulating agents. | |
Tremfya (guselkumab) intravenous Targeted Immunomodulators – Skilled Administration Policy
| 1/1/2025 | Prior authorization is now required for Tremfya IV (HCPCS J1628), approved by the FDA in September 2024 for the treatment of adult patients with moderately to severely active ulcerative colitis. |
Pavblu Nypozi Hercessi | 1/1/2025 | Prior authorization is now required for Pavblu (HCPCS J3590), Nypozi (HCPCS C9173), and Hercessi (HCPCS Q5146). These agents are non-preferred products within their respective therapeutic categories. |
Updates to existing prior authorization programs | ||
Drug(s) | Effective date | Policy & additional information |
1/1/2025 | We will no longer require prior authorization for harvesting, preparation, and administration of chimeric antigen receptor T-cell therapy medications. However, the medications themselves will continue to require prior authorization. Refer to this article for more information. | |
1/1/2025 | Updates to criteria to align with MassHealth guidance and FDA labels. | |