Updated to include coverage criteria for oral CGRP inhibitors (Ubrelvy and Nurtec) and IV Vyepti.
BI653New
Tazverik
06/01/20
Used to treat epithelioid sarcoma; requires pre-authorization. Oral specialty drug; must be obtained through a contracted specialty pharmacy.
BI654 New
Ayvakit (avapritinib)
06/01/20
Used to treat gastrointestinal stromal tumors (GIST); requires pre-authorization. Oral specialty drug; must be obtained through a contracted specialty pharmacy.
BI655 New
Sarclisa
06/01/20
Used to treat multiple myeloma when other treatments have failed. Requires pre-authorization. Considered a specialty drug; covered under the medical benefit.
Updated PrEP medications, breast cancer prophylaxis coverage, tobacco cessation and aspirin. Deleted iron supplementation as it is no longer a USPSTF A or B recommendation.
Updated to require dated lab report of elevated eosinophil count.
For questions about QualChoice Medical Coverage Policies, please contact your Provider Relations Representative at 800.235.7111 or 501.228.7111, ext. 7004, Monday through Friday, 8:00 a.m. to 5:00 p.m.