Medical-benefit drug prior authorization and step therapy changes for Medicare Advantage
Updates to prior authorization and step therapy requirements for certain drugs administered under the medical benefit for Medicare Plus Blue and BCN Advantage members. Affects providers billing these drugs in outpatient settings or physician offices.
Adzynma (ADAMTS13, recombinant-krhn) and Wainua (eplontersen) will require prior authorization starting March 1, 2024.
Step therapy requirements added requiring trial and failure of Vyvgart or Vyvgart Hytrulo (and, later, also Rystiggo) before coverage of Zilbrysq for myasthenia gravis, effective Feb 12 and April 1, 2024 depending on the requirement.
Step therapy requirements added requiring trial and failure of Vyvgart or Vyvgart Hytrulo (and, later, also Rystiggo) before coverage of Soliris and Ultomiris for myasthenia gravis, effective March 1 and April 1, 2024.
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