Policy updates include:

• In initial approval criteria, separated diabetic macular edema and diabetic retinopathy into a new section and clarified request is for Cimerli or Lucentis

Policy updates include:

• Added pediatric extension to include age ≥ 6 months and weight ≥ 6 kg for prophylaxis of cytomegalovirus in patients who are cytomegalovirus- seropositive recipients of an allogenic hematopoietic stem cell transplant and age ≥ 12 years and weight ≥ 40 kg for prophylaxis of cytomegalovirus in kidney transplant recipients at high risk
• Added newly approved dosage form (oral pellets)

Policy updates include:

• For progressive familial intrahepatic cholestasis, updated criteria with pediatric extension from 5 years to 12 months of age and older, added criteria for “request is for oral solution 19 mg/mL strength”, and updated maximum dosing criteria in initial and continued therapy to align with prescribing information
• For Alagille syndrome initial and continued therapy, added criteria for “request is for oral solution 9.5 mg/mL strength”
• Added new 19 mg/mL strength oral solution
• For Appendix F, added supplemental information on different strengths
• Updated section V to align with prescribing information dosing

Policy updates include:

• For Simlandi, added new prefilled syringe formulation and strengths [20 mg/0.2 mL, 40 mg/0.4 mL, 80 mg/0.8 mL]
• For section V, added Simlandi pediatric dose for polyarticular juvenile idiopathic arthritis [15 kg to less than 30 kg: 20 mg every other week] and pediatric dose for Crohn’s disease [17 kg to less than 40 kg: 80 mg subcutaneous on Day 1, 40 mg subcutaneous on Day 15, then 20 mg subcutaneous every other week starting on Day 29]
• For Tofidence, added coverage for COVID-19 and giant cell arteritis
• For section V, added Tofidence dosing for giant cell arteritis• For Appendix M, added supplemental information for Tofidence
• Added HCPCS code [Q5135] for Tyenne
• For Taltz: added new strengths for single-dose prefilled syringe [20 mg/0.25 mL, 40 mg/0.5 mL]

Policy updates include:

• For graft-versus-host disease, revised tablet quantity limit to 2 due to twice daily regimen

Policy updates include:

• Added new Eylea biosimilars Enzeevu and Pavblu; expanded retinopathy of prematurity indication criteria to also allow use of the biosimilars – Opuviz, Yesafili, Ahzantive, Enzeevu, and Pavblu

Policy updates include:

• Added newly approved Erzofri to the policy

Policy updates include:

• Added criteria for newly Food and Drug Administration (FDA)-approved indication for use as neoadjuvant/adjuvant therapy in resectable non-small cell lung cancer
• Revised Commercial continued approval duration from 12 months to standard duration for injectables, 6 months or to the member’s renewal date, whichever is longer

Policy updates include:

• For diabetic macular edema, macular edema, and uveitis, removed required step through of intravitreal steroid injections due to lack of commercial availability (Triesence is the only intravitreal steroid injection on market, and it is currently on shortage without a known resolution date)

Policy updates include:

• Updated Fibryga with new Food and Drug Administration (FDA) indication for acquired fibrinogen deficiency

Policy updates include:

• For Omnipod 5, updated the Food and Drug Administration (FDA) Approved Indication section to reflect newly approved use of the SmartAdjust technology in adults with type 2 diabetes

Policy updates include:

• For endometrial carcinoma, updated Food and Drug Administration (FDA) approved indication to remove requirement for disease to be mismatch repair deficient (dMMR)/ microsatellite instability-high (MSI-H) when prescribed in combination with carboplatin and paclitaxel per expanded label, and clarified in criteria that stage III-IV is advanced

Policy updates include:

• Added criteria for new indication for non-small cell lung cancer in combination with Lazcluze
• For Rebervant prescribed as subsequent therapy after Tagrisso, exon 19 insertion mutation was removed and the sensitizing epidermal growth factor receptor mutations were revised according to National Comprehensive Cancer Network (NCCN) exon characterization

Policy updates include:

• Removed specification of New York Heart Association (NYHA) Class II or Class III from criteria per expanded Food and Drug Administration (FDA)-approved indication
• Removed ascites from contraindications and revised dosage strength from 80 mg/mL to 80 mg/10 mL

Policy updates include:

• Added newly approved Zurnai to the policy

Policy updates include:

• Added newly approved Food and Drug Administration (FDA) indication of immunoglobulin A nephropathy

Policy updates include:

• Added newly approved Crexont to the policy

Policy update includes:

• For chronic migraine continuation therapy requests, modified maximum dosing to allow up to 195 units per treatment session

Policy update includes:

• Added new Food and Drug Administration (FDA) approved indication for malignant pleural mesothelioma