Medical drug program updates
New prior authorization programs | ||
Drug(s) | Effective date | Policy & additional Information |
Adzynma | 4/1/2024 | Prior authorization is now required for Adzynma (HCPCS J3590, C9167), approved in November 2023 for the treatment of thrombotic thrombocytopenic purpura. |
Lyfgenia (lovotibeglogene autotemcel) | 4/1/2024 | Prior authorization is now required for Lyfgenia, an autologous hematopoietic stem cell-based gene therapy approved by the FDA in December 2023 for the treatment of patients 12 years of age or older with sickle cell disease and a history of vaso-occlusive events. |
Casgevy (exagamglogene autotemcel) | 4/1/2024 | Prior authorization is now required for Casgevy, an autologous genome edited hematopoietic stem cell-based gene therapy approved by the FDA in December 2023 for the treatment of sickle cell disease (SCD) in patients 12 years and older with recurrent vaso-occlusive crises. |
Omvoh, Tofidence | 4/1/2024 | Targeted Immunomodulators Skilled Administration Prior authorization is now required for Omvoh (HCPCS J3590), approved in September 2023 for the treatment of ulcerative colitis, and for Tofidence (HCPCS Q5133), approved in September 2023 for the treatment of rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis. |
Updates to existing prior authorization programs | ||
Drug(s) | Effective date | Policy & additional Information |
Vyondys 53 | 6/1/2024 | |