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Commercial Medical Policy Notification Effective November 1, 2025 Posted September 1, 2025

Medical PolicyRevision
Spesolimab-sbzo (Spevigo®) “Notification” (PDF)Added requirement for self-administration unless certain criteria are met, or the request is for the 150 mg/mL prefilled syringe to be used as a 600 mg SC loading dose. Added Site of Care medical necessity criteria. Minor adjustments made throughout policy and to formatting for clarity according to FDA label. Policy notification given 9/1/2025 for effective date 11/1/2025.

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