| Medical Policy |
Revision |
| Belimumab (Benlysta®) "Notification" |
Added requirement for use of the self-administered product in patients 18 years of age or older unless certain criteria are met. Policy notification given 2/3/2022 for effective date 4/4/2022. |
| Immunoglobulin Therapy "Notification" |
Added requirement of trial and failure of two preferred IVIG and/or SCIG products prior to use of non-preferred Asceniv unless other criteria are met. Adjusted duration of approval for Asceniv to 6 months for all indications. Policy notification given 2/3/2022for effective date 4/4/2022. |
| Treatment of Hereditary Angioedema "Notification" |
Removed requirement of two laboratory levels drawn at separate times for HAE-I diagnostic criteria. For prophylactic use (Cinryze), added additional clarification of 2 or more attacks within the last 2 months for history of moderate to severe HAE attacks. Changed age requirement for Berinert to 5 years of age or older. Policy notification given 2/3/2022for effective date 4/4/2022. |
Blue Connect