Used to treat mantle cell lymphoma (MCL); requires pre-authorization. Oral specialty drug; must be obtained through a contracted specialty pharmacy.
BI644New
Enhertu
05/01/20
Used to treat advanced or unresectable breast cancer; requires pre-authorization. Considered a specialty medication.
BI645New
Inrebic
05/01/20
Used in the treatment of myelofibrosis; requires pre-authorization. Oral specialty drug; must be obtained through a contracted specialty pharmacy.
BI646New
Padcev
05/01/20
Used to treat advanced urothelial cancer; requires pre-authorization. Specialty drug covered under the medical benefit.
BI647New
Reblozyl
05/01/20
Used to treat anemia in adult patients with beta thalassemia; requires pre-authorization and is a specialty medication.
BI648New
Rozlytrek
05/01/20
Used to treat solid tumors with specific characteristics; requires pre-authorization. Oral specialty drug; must be obtained through a contracted specialty pharmacy.
BI649New
Trikafta
05/01/20
Used in the treatment of cystic fibrosis; requires pre-authorization. Oral specialty drug; must be obtained through a contracted specialty pharmacy.
BI650New
Vascepa
05/01/20
Used to treat severe hypertriglyceridemia; requires pre-authorization.
BI651New
Wakix
05/01/20
Used to treat sleepiness (EDS) in adults with narcolepsy; requires pre-authorization. Considered a specialty drug; must be obtained through a contracted specialty pharmacy.
BI652New
Adakveo
05/01/20
Used to reduce vasocclusive crises (VOCs) in patients age 16 and older with sickle cell disease (SCD); requires pre-authorization. Considered a specialty medication.
Used to treat acute lymphoblastic leukemia (ALL). Both require pre-authorization and are considered specialty drugs.
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.