News

Effective May 2, 2022: Pharmacy and Biopharmacy Policies

Date: 04/25/22

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 May 2, 2022, 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
Cabotegravir (Apretude), Cabotegravir/Rilpivirine (Cabenuva) (CP.PHAR.573)	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter	Policy updates include: Removal of oral lead-doses of Vocabria and Endurant requirement for Cabenuva per updated PI Added pediatric extension for age 12 years of age and older and weighing at least 35 kgs for Cabenuva per updated PI
CNS Stimulants (CP.PMN.92)	Ambetter	Policy updates include: Added new agent Xelstrym to policy
GLP-1 receptor agonists (HIM.PA.53)	Ambetter	Policy updates include: Added new dosage strength (2 mg) form for Ozempic
Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (CP.PMN.183)	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), and CHIP	Policy updates include: Added new dosage strength (2 mg) form for Ozempic
Ruxolitinib (Jakafi) (CP.PHAR.98)	Ambetter	Policy updates include: Revised maximum dose of Opzelura from 60 g per month to 60 g per week per PI

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.