Medical Policy Updates

Notification of Policy Revisions Effective June 30, 2020 Posted March 31, 2020

Medical Policy Revision
Guselkumab (Tremfya®) and Tildrakizumab-asmn (Ilumya®) "Notification" New policy developed. Guselkumab (Tremfya) or tildrakizumab-asmn (Ilumya) may be considered medically necessary for the treatment of plaque psoriasis in adult patients (≥ 18 years of age) when specified medical criteria and guidelines are met. Added HCPCS codes J1628 and J3245 to Billing/Coding section. References added. Medical Director review 3/2020. Notification given 3/31/2020 for effective date 6/30/2020.