Medical Necessity Guideline updates
Medical Necessity Guideline updates
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MNG Title |
Effective Date |
Summary |
|---|---|---|
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Sept. 1, 2023 |
Criteria expanded to reflect FDA guidance. |
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July 1, 2023 |
Prior authorization now required for Altuviiio (HCPCS J3490), approved by the FDA in February 2023 for the treatment of hemophilia A. |
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July 1, 2023 |
In alignment with guidance from the National Comprehensive Cancer Network, CarePartners of Connecticut’s initial approval criteria no longer require that the patient first try Keytruda and Opdivo before being eligible for coverage of Opdualag. |
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July 1, 2023 |
Prior authorization now required for Lamzede (HCPCS J3490), approved in February 2023 for the treatment of non-central nervous system manifestations of alpha-mannosidosis. |
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July 1, 2023 |
One overarching MNG has been developed for Retinal Disorders. The following individual drug policies have been retired, and their criteria (which have not changed) can now be found on the overarching MNG for this drug class:
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July 1, 2023 |
Vivimusta (HCPCS J9506), a drug in the Bendamustine HCI injection class used to treat chronic lymphocytic leukemia, has been added as a non-preferred product and now requires prior authorization. Generic Bendamustine HCI (HCPCS J9033) has been added as a preferred product and does not require prior authorization. |