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. |