New York
Provider Communications
Medical drug benefit clinical criteria updates – December 2020
Visit clinical criteria to search for specific policies. If you have questions or would like additional information, use this email.
Please see the explanation/definition for each category of clinical criteria below:
- New: newly published criteria
- Revised: addition or removal of medical necessity requirements, new document number
- Updates marked with an asterisk (*) notate that the criteria may be perceived as more restrictive
Please share this notice with other members of your practice and office staff.
Note: The clinical criteria listed below applies only to the medical drug benefits contained within the member’s medical policy. This does not apply to pharmacy services.
|
Effective date |
Document number |
Clinical Criteria title |
New or revised |
|
April 8, 2021 |
ING-CC-0185* |
Oxlumo (lumasiran) |
New |
|
April 8, 2021 |
ING-CC-0184* |
Danyelza (naxitamab-gqgk) |
New |
|
April 8, 2021 |
ING-CC-0154 |
Givlaari (givosiran) |
Revised |
|
April 8, 2021 |
ING-CC-0124 |
Keytruda (pembrolizumab) |
Revised |
|
April 8, 2021 |
ING-CC-0002 |
Colony Stimulating Factor Agents |
Revised |
|
April 8, 2021 |
ING-CC-0032* |
Botulinum Toxin |
Revised |
|
April 8, 2021 |
ING-CC-0015 |
Infertility and HCG Agents |
Revised |
Featured In:
April 2021 Newsletter