News

Effective August 2, 2021: Pharmacy and Biopharmacy Policies

Date: 07/23/21

Superior HealthPlan has updated certain pharmacy and biopharmacy policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result the following policies are effective on August 2, 2021 at 12:00AM.

Changes in these policies reflect preauthorization requirement amendments that are less burdensome to insureds, physicians, or health care providers.

POLICY	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
Secukinumab (Cosentyx) (CP.PHAR.261)	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter	Policy updates include: Updated PsO age requirement from ≥ 18 years to ≥ 6 years per FDA pediatric expansion Added new 75 mg/0.5 mL prefilled syringe for pediatric patient
Biologic DMARDs (HIM.PA.SP60)	Ambetter	Policy updates include: Updated Cosentyx PsO age requirement from ≥ 18 years to ≥ 6 years per FDA pediatric expansion Added new 75 mg/0.5 mL prefilled syringe for pediatric patients. Added new Skyrizi 150 mg/mL prefilled pen and syringe formulations

POLICY

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Secukinumab (Cosentyx) (CP.PHAR.261)

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter

Policy updates include:

Updated PsO age requirement from ≥ 18 years to ≥ 6 years per FDA pediatric expansion
Added new 75 mg/0.5 mL prefilled syringe for pediatric patient

Biologic DMARDs (HIM.PA.SP60)

Ambetter

Policy updates include:

Updated Cosentyx PsO age requirement from ≥ 18 years to ≥ 6 years per FDA pediatric expansion
Added new 75 mg/0.5 mL prefilled syringe for pediatric patients.
Added new Skyrizi 150 mg/mL prefilled pen and syringe formulations

To review all policies, please visit Superior’s Clinical, Payment & Pharmacy Policies webpage.

Prior to updates, pharmacy and biopharmacy clinical policies are reviewed and approved by the Pharmacy and Therapeutics (P&T) Committee.

For questions or additional information, please contact Superior’s Pharmacy Department at 1-800-218-7453, ext. 22272.