| Policy Name |
Revised Criteria |
| Allogeneic Processed Thymus Tissue-agdc (Rethymic®) |
Original medical policy criteria issued. |
| Infliximab (Remicade®) and Infliximab Biosimilars |
Added infliximab (generic product) to policy with same criteria requirements and product preference as infliximab (Remicade); removed alternative disease-modifying antirheumatic drugs (DMARDs) as combination therapy requirement option for rheumatoid arthritis; removed maximum units column from FDA dosing reference table. |
| Injectable Clostridial Collagenase for Fibroproliferative Disorders |
Adjusted number of visits for Peyronie’s disease duration of approval for initial and continuation for clarity with no change to policy intent. |
| Ocular Angiogenesis Inhibitor Agents |
Added newly approved Susvimo to policy for treatment of neovascular (wet) age-related macular degeneration (AMD) with requirement of trial and failure of bevacizumab and Lucentis; added associated dosing and maximum units to FDA label reference table. |
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