Notification of Policy Revisions Effective April 1, 2022 (Posted February 15, 2022)

Policy Name Revised Criteria
Injectable and Healthcare Administered Oncology Drugs “Notification” Added newly approved Kimmtrak to policy for treatment of HLA-A*02:01-positive adults with unresectable or metastatic uveal melanoma, and associated dosing to FDA label reference table. Addition of Erwinaze, Rybrevant, Rylaze, and Tivdak to remain on notice for effective date 4/1/2022. Additional policy notification given 2/15/2022 for effective date 4/1/2022.