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Notification of Drug Policy Revisions Effective October 1, 2024 (Posted August 2, 2024)

Medical Drug Policy NameRevised Criteria
Esketamine (Spravato) Nasal Spray Notification (PDF)For treatment-resistant depression indication, adjusted requirement of inadequate response to at least two different oral antidepressants to specify from at least two different drug classes. Policy notification given 8/2/2024 for effective date 10/1/2024.
Etranacogene dezaparvovec-drlb (Hemgenix) Notification (PDF)Updated moderately severe to severe disease criteria requirement to Factor IX baseline residual level less than or equal to 2 IU/dL (≤ 2% of normal circulating Factor IX). Policy notification given 8/2/2024 for effective date 10/1/2024.