Medical Policy Updates

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Notification of Policy Revisions Effective August 1, 2022 (Posted June 1, 2022)

Policy Name Revised Criteria
Eculizumab (Soliris®) “Notification” Added requirement for trial and failure of both ravulizumab (Ultomiris) AND efgartigimod (Vyvgart) for gMG indication. Policy notification given 6/1/2022 for effective date 8/1/2022.
Ocular Angiogenesis Inhibitor Agents “Notification” For Lucentis requests, added requirement of a documented serious adverse event that required medical intervention to Byooviz that is not anticipated with Lucentis and a submitted MedWatch Adverse Event Reporting form. For Susvimo requests, changed trial and failure requirement to one ranibizumab product (e.g., Byooviz, Lucentis). Policy notification given 6/1/2022 for effective date 8/1/2022.