Medical Policy Updates

Notification of Policy Revisions Effective February 9, 2021 (Posted December 8, 2020)

Medical Policy Revision
Onasemnogene abeparvovec (Zolgensma®) "Notification" Added the following statement to “When Covered” section: “For certain identified gene and cellular therapies such as onasemnogene abeparvovec (Zolgensma), when coverage is available and the individual meets medically necessary criteria, distribution from a specialty pharmacy provider due to cost (distribution channel restriction) may be required in order for coverage to be provided. Please contact Care Management to coordinate this therapy.” Specialty Matched Consultant Advisory Panel review 10/21/2020. Medical Director review 11/2020. Policy notification given 12/8/2020 for effective date 2/9/2021.
Voretigene Neparvovec-rzyl (Luxturna®) "Notification" Added the following statement to "When Covered" section: "For certain identified gene and cellular therapies such as voretigene neparvovec-rzyl (Luxturna), when coverage is available and the individual meets medically necessary criteria, distribution from a specialty pharmacy provider due to cost (distribution channel restriction) may be required in order for coverage to be provided. Please contact Care Management to coordinate this therapy." Medical Director review 11/2020. Policy notification given 12/8/2020 for effective date 2/9/2021.