Skip to Main Content

Renueve antes del 15 de diciembre para tener cobertura el 1 de enero. Mantén tu cobertura con Ambetter Health.

Renueve antes del 15 de diciembre para tener cobertura el 1 de enero. Mantén tu cobertura con Ambetter Health.

Navigation Menu

News

Effective October 3, 2022: Pharmacy and Biopharmacy Policies

Fecha: 27/09/22

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 October 3, 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

Belimumab (Benlysta) (CP.PHAR.88)

Ambetter

Policy updates include:

  • Updated FDA approved indications to expand age down to 5 years of age for LN

Biologic DMARDs (HIM.PA.SP60)

Ambetter

Policy updates include:

  • For PsA, updated criteria and dosing per FDA approved pediatric extension.

Factor IX Human Recombinant (CP.PHAR.218)

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

Policy updates include:

  • For Rebinyn, added newly approved indication for routine prophylaxis and added new 3,000 IU dosage form

Fam-trastuzumab Deruxtecan-nxki (Enhertu) (CP.PHAR.456)

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

Policy updates include:

  • Added criteria for new FDA-approved indications for NSCLC and HER2-low breast cancer

Ibrutinib (Imbruvica) (CP.PHAR.126)

Ambetter

Policy updates include:

  • Added pediatric expansion for cGVHD and new oral suspension formulation

Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) (HIM.PA.SP63)

Ambetter

Policy updates include:

  • Added pathway to Vosevi approval for a specific treatment-naïve genotype 3 scenario per AASLD guideline

Ustekinumab (Stelara) (CP.PHAR.264)

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

Policy updates include:

  • For PsA, updated criteria and dosing per FDA approved pediatric extension

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.