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Medical Coverage Changes

Thursday, October 31, 2019

New Prior Authorization Programs
Effective for fill dates on or after January 1, 2020, CarePartners of Connecticut will require medical prior authorization for Rituxan® for use other than chronic lymphocytic leukemia (CLL) and non-Hodgkin’s lymphoma (NHL). Prior authorization of Rituxan will not be required for the treatment of CLL and NHL. These changes will apply to members currently utilizing Rituxan, as well to members initiating a new course of treatment. For these requests, the prescribing provider must request coverage through the medical review process subject to the applicable medical necessity guidelines, including Medicare National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).

Coverage of Kanjinti (trastuzumab-anns)
CarePartners of Connecticut covers Kanjinti (trastuzumab-anns), which was approved by the FDA and launched earlier this year as a biosimilar to Herceptin® (trastuzumab) for the treatment of HER2-overexpressing breast cancer and HER2-overexpressing metastatic gastric or gastroesophageal junction adenocarcinoma. Kanjinti (trastuzumab-anns) and Herceptin (trastuzumab) are covered without prior authorization.

Coverage of Mvasi (bevacizumab-awwb)
CarePartners of Connecticut covers Mvasi (bevacizumab-awwb), which was approved by the FDA and launched earlier this year as a biosimilar to Avastin® (bevacizumab) for the treatment of metastatic colorectal cancer, non-squamous non-small cell lung cancer, glioblastoma, metastatic renal cell carcinoma and cervical cancer. Mvasi (bevacizumab-awwb) and Avastin (bevacizumab) are covered without prior authorization.

Medical Benefit Drugs Requiring Prior Authorization Reference Document
CarePartners of Connecticut has created a list of medical benefit drugs that currently require prior authorization under Part B. Prior authorization programs are in place due to specific indication(s) for use, cost and/or significant safety concerns. Coverage of the drugs on this list is subject to NCDs and LCDs.