|
Medical Policy Number
| Medical Policy Name | Effective Date of Change | Description of Changes |
|---|
|
| Continuous Glucoe Monitoring | 01/01/22 | Freestyle Libre and Dexcom no longer require PA under Pharmacy benefit. |
|
| Enzyme Replacement Therapy for Lysosomal Disorders | 01/01/22 | Updated with Nexviazyme (C9085) coverage criteria for late onset Pompe disease. |
|
| Erwinaze | 01/01/22 | Updated to include Rylaze (J9021), updated criteria for ALL, and added coverage criteria for lymphoblastic lymphoma. |
|
| Keytruda | 05/01/22 | Updated criteria for several indications and added criteria for newly approved indications. |
|
| Imlygic | 01/01/22 | New drug used to treat melanoma. |
|
| Jemperli | 01/01/22 | New drug used to treat endometrial carcinoma and solid tumors. |
|
| Margenza | 01/01/22 | New drug used to treat metastatic breast cancer. |
|
| Rybrevant | 01/01/22 | New drug used to treat lung cancer. |
|
| Saphnelo | 01/01/22 | New drug used to treat systemic lupus erythematosus (SLE). |
|
| Tivdak | 01/01/22 | New drug used to treat cervical cancer. |
|
| Zynlonta | 01/01/22 | New drug used to treat a type of lymphoma. |
