CarePartners of Connecticut medical drug program updates
New prior authorization programs
| MNG title | Effective date | Summary |
| Epkinly (epcoritamab-bysp) | Dec. 1, 2023 | Prior authorization will be required for the drug Epkinly (HCPCS J9999), approved by the FDA in May 2023 to treat large B-cell lymphoma and high-grade B-cell lymphoma. |
| Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) | Dec. 1, 2023 | Prior authorization is now required for Vyvgart Hytrulo (HCPCS J3590), approved June 2023 for the treatment of generalized myasthenia gravis in adult patients who are anti-acetylcholine receptor antibody positive |
| Columvi (glofitamab-gxbm) | Oct. 1, 2023 | Prior authorization will be required for Columvi (HCPCS J9999), approved by the FDA in June 2023 for the treatment of diffuse large B-cell lymphoma not otherwise specified and large B-cell lymphoma resulting from follicular lymphoma for adults whose cancer has relapsed or become resistant to treatment after at least two previous rounds of systemic therapy. |
| Rystiggo (rozanolixizumab-noli) | Oct. 1, 2023 | Prior authorization will be required for Rystiggo (HCPCS J3590), approved by the FDA in June 2023 for the treatment of generalized myasthenia gravis in adults who are anti-acetylcholine receptor- or anti-muscle-specific tyrosine kinase antibody-positive. |
| Adstiladrin | Oct. 1, 2023 | New MNG for Adstiladrin (HCPCS J9020), a non-replicating adenoviral vector-based gene therapy approved by the FDA in December 2022 to treat high-risk Bacillus Calmette-Guerin- unresponsive non-muscle invasive bladder cancer with carcinoma in situ with or without papillary tumors. Prior authorization is required. |
Updates to existing prior authorization programs
| Drug | Eff. date | Policy & Additional Information |
| Altuviiio | Dec. 1, 2023 | Altuviiio |
| Hemlibra | Dec. 1, 2023 | Hemlibra |
| Ultomiris | Dec. 1, 2023 | Ultomiris |
| Soliris | Dec. 1, 2023 | Soliris |
| Vyvgart | Dec. 1, 2023 | Vyvgart and Vyvgart Hytrulo |
| Advate, Adynovate, Afstyla, Alphanate, Alphanine, Alprolix, Benefix, Coagadex, Corifact, Eloctate, Esperoct, Feiba, Hemofil, Humate-P, Idelvion, Ixinity, Jivi, Koate, Kovaltry, Monoclate, Mononine, Novoeight, Novoseven, Nuwiq, Obizur, Profilnine, Rebinyn, Recombinate, Rixubis, Sevenfact, Tretten, Vonvendi, Wilate, Xyntha | Dec. 1, 2023 | Factor Products |
| Myobloc (rimabotulinumtoxin B) | Jan. 1, 2024 | Myobloc |
| Dysport (abobotulinumtoxin A) | Jan. 1, 2024 | Dysport |
| Evenity (romosozumab-aqqg) | Jan. 1, 2024 | Evenity (romosozumab-aqqg) |
| Prolia (denosumab) | Jan. 1, 2024 | Prolia (denosumab) |
| Xgeva (denosumab) | Jan. 1, 2024 | Xgeva |
| Signifor LAR (pasireotide) | Jan. 1, 2024 | Somatostatin Analogs for Non-oncology Indications |