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) | Effective date | Policy & additional information |
Omisirge | 10/1/2024 | Omisigre (HCPCS J3590), which was approved by the FDA in April 2023 for the treatment of patients with hematologic malignancies, is now covered with prior authorization. MassHealth’s criteria will be used for review. |
Anktiva (nogapendekin alfa inbakicept-pmln) | 10/1/2024 | Anktiva (nogapendekin alfa inbakicept-pmln) Prior authorization is now required for Anktiva (HCPCS J9999), approved by the FDA in April 2024 for the treatment of adult patients with Bacillus Calmette-Guérin unresponsive nonmuscle invasive bladder cancer with carcinoma in situ with or without papillary tumors. |
Tyenne (tocilizumab-aazg)
| 10/1/2024 | Targeted Immunomodulators Skilled Administration Prior authorization is now required for Tyenne (HCPCS Q5135), approved by the FDA in March 2024 for the treatment of adults with rheumatoid arthritis, adults with giant cell arteritis, patients at least 2 years of age with polyarticular juvenile idiopathic arthritis, and patients at least 2 years of age with systemic juvenile idiopathic arthritis. |
Updates to existing prior authorization programs | ||
Givlaari (givosiran) | 12/1/2024 | Adding provider specialty requirements and updating diagnosis requirements. |
Vyjuvek | 10/1/2024 | Updated policy to specify that Vyjuvek will not be authorized in members who are currently on Filsuvez (birch triterpenes topical gel), as combination use with Vyjuvek and Filsuvez has not been studied. |
New-to-Market (NTM) Drugs | 10/1/2024 | MNG name updated from New to Market (NTM) Drug Evaluation Process Under The Medical Benefit to New to Market (NTM) Drugs. Minor criteria update to add clarification related to gene therapies. |