Brolucizumab (Beovu) (CP.PHAR.445)

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

Policy updates include:

• Criteria added for new FDA approved indication of DME

Dabrafenib (Tafinlar) (CP.PHAR.239)

Ambetter

Policy updates include:

• Revised criteria to include new FDA-approved indication of BRAF V600E mutation-positive solid tumors

Ivosidenib (Tibsovo) (CP.PHAR.137)

Ambetter

Policy updates include:

• Revised criteria per updated FDA approved indication to include combination therapy with azacitidine or monotherapy for treatment of AML

Risankizumab-rzaa (Skyrizi) (CP.PHAR.426)

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

Policy updates include:

• Updated policy with Crohn’s disease indication

Risdiplam (Evrysdi) (CP.PHAR.477)

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

Policy updates include:

• Updated criteria with new pediatric expansion indication for pre-symptomatic infants < 2 months old

Rituximab (Rituxan), Rituximab-arrx (Riabni), Rituximab-pvvr (Ruxience), Rituximab-abbs (Truxima), RituximabHyaluronidase (Rituxan Hycela) (CP.PHAR.260)

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

Policy updates include:

• For Riabni, updated FDA approved indications to include RA per updated prescribing information

Trametinib (Mekinist) (CP.PHAR.240)

Ambetter

Policy updates include:

• Revised criteria to include new FDA-approved indication of BRAF V600E mutation-positive solid tumors