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| Medical Drug Policy Name | Revised Criteria |
|---|---|
| Esketamine (Spravato) Nasal Spray Notification | 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 | 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. |
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