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Effective July 1, 2021: Pharmacy and Biopharmacy Policies

Date: 06/24/21

Superior HealthPlan has updated certain pharmacy and biopharmacy 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 July 1, 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

Nivolumab (Opdivo) (CP.PHAR.121)

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

Policy updates include:

  • Added new FDA-approved indications of gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma

Elexacaftor-ivacaftor-tezacaftor (Trikafta) (CP.PHAR.440)

Ambetter

Policy updates include:

  • Revised to include pediatric expansion and new dose strength

Voclosporin (Lupkynis) (CP.PHAR.504)

Ambetter

Policy updates include:

  • Removed requirement for prior trial of immunosuppressive therapy to align with FDA labeling

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 1-800-218-7508