Injectable medication updates

The following prior authorization updates have been made to the injectable medications currently in the Magellan Rx program. Magellan Rx will review all prior authorization requests for these specialty injectable medications, along with other specialty medications that are already part of the program when administered in:
  • An outpatient facility
  • A patient's home
  • A physician's office
 
Policy Changes 
Effective September 10, 2020
Keytruda (J9271): 
  • Cutaneous Melanoma: To adjuvant treatment, limited use to patients with stage 3 disease who have undergone complete resection.
  • Gastric Cancer: Specified prior therapy must have included fluoropyrimidine- and platinum-containing chemotherapy, and patients with HER2-positive disease must have previously failed HER2- directed therapy.
  • Esophageal Cancer: Specified prior therapy must have included fluoropyrimidine- and platinum-containing chemotherapy.
  • Merkel Cell Carcinoma: Limited use to first-line therapy.
  • SCCHN: In first-line therapy, specified use is for non-nasopharyngeal disease. To subsequent therapy, limited use as a single-agent to patients with PD-L1- expressing tumors and removed use in combination with fluorouracil and platinum chemotherapy.
  • Classic Hodgkin Lymphoma: To relapsed or refractory disease, specified must be used after three or more prior lines of therapy and removed use in patients who are transplant ineligible or have failed second-line chemotherapy. Also removed use as palliative therapy in patients more than 60 years old and post-allogeneic transplant.
  • PMBCL: Added patient must have progressed after autologous stem cell transplant or if ineligible for autologous stem cell transplant, after two or more prior lines of therapy.
  • MSI-H Cancer: To CRC, limited use to unresectable advanced or metastatic disease that has progressed following treatment with a fluoropyrimidine, oxaliplatin, and/or irinotecan, and primary treatment in patients with unresectable metastatic disease who have received previous adjuvant treatment with FOLFOX or CAPOX within the past 12 months, and removed all other NCCN-recommended indications (e.g., primary and adjuvant treatment). To Pancreatic Adenocarcinoma, removed use in recurrent disease after resection and first-line therapy. To Bone Cancer, removed use in Ewing Sarcoma. To Hepatobiliary Adenocarcinoma, removed Gallbladder Cancer, revised use to subsequent therapy, and removed use in resected Gross Residual Disease. Removed Penile Cancer, Testicular Cancer, Vulvar Squamous Cell Carcinoma, and Occult Primary Cancer of Unknown Primary.
  • SCLC: Limited use to metastatic disease with progression on or after platinum-based treatment and at least one other line of therapy, and removed NCCN recommendation for relapsed or primary progressive disease.
  • MF/SS: Removed use in primary therapy. RCC: Limited use to first-line therapy.