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Medical Drug Policy Name | Revised Criteria |
|---|---|
| Preferred Injectable Oncology Program Notification | Changed requirement for trial and failure of preferred trastuzumab biosimilar products to include Kanjinti and Trazimera; adjusted non-preferred trastuzumab biosimilar products to include Herzuma, Ogivri, and Ontruzant. Added Ogivri (Q5114) to restricted products; removed Trazimera (Q5116) from restricted products (now unrestricted). Policy notification given 1/10/2024 for effective date 4/1/2024. |
| White Blood Cell Growth Factors Notification | Changed requirement for trial and failure of preferred pegfilgrastim biosimilar products to include Fulphila and Nyvepria; adjusted non-preferred pegfilgrastim biosimilar products to include Fylnetra, Stimufend, Udenyca/Udenyca Onbody and Ziextenzo. Added Udenyca/Udenyca Onbody (pegfilgrastim-cbqv) and Ziextenzo (pegfilgrastim-bmez) to restricted products; removed Fulphila (pegfilgrastim-jmdb) and Nyvepria (pegfilgrastim-apgf) from restricted products (now unrestricted). Added new to market Udenyca formulation, Udenyca Onbody (pegfilgrastim-cbqv), to policy as non-preferred with same criteria as Neulasta OnPro. Policy notification given 1/10/2024 for effective date 4/1/2024. |
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