Clinical criteria updates for specialty pharmacy
The following Clinical Criteria documents were endorsed at a Clinical Criteria meeting. To access the clinical criteria information please click here.
Revised Clinical Criteria effective August 1, 2021
The following clinical criteria were reviewed with no significant change to the medical necessity indications or criteria.
- ING-CC-0037 Kanuma (sebelipase alfa)
- ING-CC-0043 Monoclonal Antibodies to Interleukin-5
- ING-CC-0057 Krystexxa (pegloticase)
- ING-CC-0066 Monoclonal Antibodies to Interleukin-6
- ING-CC-0068 Growth Hormone
- ING-CC-0069 Egrifta (tesamorelin)
- ING-CC-0111 Nplate (romiplostim)
- ING-CC-0137 Cablivi (caplacizumab-yhdp)
- ING-CC-0153 Adakveo (crizanlizumab)
- ING-CC-0162 Tepezza (teprotumumab-trbw)
August 2021 Newsletter