Medical Policy Updates

Medical Criteria Update March 22, 2022

Medical Criteria Reason for Update
CAR-T Therapy Added new to market drug to policy with indication of the treatment of adults with relapsed or refractory multiple myeloma after four or more prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody. Updated dosing table/max units with new drug.
Erythropoiesis-Stimulating Agents (ESAs) Criteria change: Removal of code Q5105 from dosing table (no review required, this code was never added to the PPA list).