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Notification of Drug Policy Revisions Effective January 1, 2025 (Posted November 1, 2024)
| Medical Drug Policy Name | Revised Criteria |
|---|---|
| Interleukin-5 Antagonists Notification (PDF) | Added requirement for trial and failure of the provider-administered formulations of Fasenra and Nucala prior to use of Cinqair within initial and continuation criteria. Adjusted maximum units for Cinqair according to FDA labeled dosing. Policy notification given 11/1/2024 for effective date 1/1/2025. |
| Ocular Angiogenesis Inhibitor Agents Notification (PDF) | For Beovu, added requirement for trial and failure of one of the following products: Eylea, Eylea HD, Lucentis, Byooviz, Cimerli, or Vabysmo. For Lucentis, removed requirement for trial and failure of Byooviz and Cimerli. Adjusted maximum units for Eylea, Lucentis, Byooviz, Cimerli, and Vabysmo for clarity according to FDA labeled dosing. Removed Macugen from policy due to market withdrawal and product discontinuation. Additional minor updates made to formatting throughout policy for clarity. Policy notification given 11/1/2024 for effective date 1/1/2025. |
| Tocilizumab (Actemra®) and Tocilizumab Biosimilars Notification (PDF) | Changed requirement for trial and failure of a preferred tocilizumab biosimilar product to include Tyenne (tocilizumab-aazg) and adjusted non-preferred tocilizumab products to include Actemra (tocilizumab) and Tofidence (tocilizumab-bavi). Updated trial and failure criteria to also allow for presence of a documented serious adverse event requiring medical intervention from the preferred tocilizumab biosimilar product that is not anticipated with the requested non-preferred tocilizumab product, with required submission of an FDA MedWatch Adverse Event Reporting Form. Policy notification given 11/1/2024 for effective date 1/1/2025. |
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