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| Policy Name | Revised Criteria |
|---|---|
| Botulinum Toxin Injection | Adjusted duration of approval in initial and continuation sections to 48 weeks, and initial duration of approval for migraine to 24 weeks. Policy notification given 8/4/2022 for effective date 10/1/2022. |
| Immunoglobulin Therapy | Added requirement of trial and failure of an IVIG product prior to use of a SCIG product unless other criteria are met. Added requirement of trial and failure of two preferred IVIG products prior to use of non-preferred IVIG products unless other criteria are met. Added requirement of trial and failure of Hizentra and Xembify prior to use of non-preferred SCIG products (Cutaquig, Cuvitru), and trial and failure of one preferred IVIG product prior to use of HyQvia unless other criteria are met. Added continuation criteria. Policy notification given 8/4/2022 for effective date 10/1/2022. |
| Injectable and Healthcare Administered Oncology Drugs | Removed Herceptin Hylecta and Rituxan Hycela from policy and added to a separate individual policy (Preferred Injectable Oncology Program). Policy notification given 8/4/2022 for effective date 10/1/2022. |
| Patisiran (Onpattro) “Notification”Patisiran (Onpattro) | Added requirement within initial and continuation sections that Onpattro will not be used in combination with Amvuttra or Tegsedi. Policy notification given 8/4/2022 for effective date 10/1/2022. |
| Preferred Injectable Oncology Program | Added Herceptin Hylecta to policy as a non-preferred product with same criteria as Herceptin. Added Rituxan Hycela to policy as a non-preferred product with same criteria as Rituxan. Policy notification given 8/4/2022 for effective date 10/1/2022. |
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