Medical drug program updates
MNG title | Effective date | Summary |
Dec. 1, 2023 | Prior authorization is now required for Elrexfio (HCPCS J9999), approved August 2023, for the treatment of adult patients with relapsed or refractory multiple myeloma who have received at least four prior lines of therapy including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody | |
Dec. 1, 2023 | Prior authorization is now required for Talvey (HCPCS J9999), approved August 2023, for the treatment of adult patients with relapsed or refractory multiple myeloma who have received at least four prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent and an anti-CD38 monoclonal antibody |
| Updates to existing prior authorization programs | ||
Drug(s) | Effective date | Policy & additional Information |
Amondys 45, Exondys 51, Viltepso, Vyondys 53 | Feb. 1, 2024 | |
Cinryze | Feb. 1, 2024 | |
Haegarda | Feb. 1, 2024 | |
Riabni, Rituxan, Rituxan Hycela, Ruxience, Truxima | Feb. 1, 2024 | |
Saphnelo | Feb. 1, 2024 | |
Scenesse | Feb. 1, 2024 | |
Takhzyro | Feb. 1, 2024 | |
Uplinza | Feb. 1, 2024 | |
Xenpozyme | Feb. 1, 2024 | |