Mirikizumab-mrkz (Omvoh) — Intravenous Infusion (Notification) Coverage Criteria
Defines medical necessity and prior authorization requirements for intravenous mirikizumab (Omvoh) for adults with moderately to severely active Crohn's disease or ulcerative colitis for Blue Cross Blue Shield North Carolina members.
For Crohn's disease: removed required trial and failure of conventional therapy and replaced allowance for severely active disease with required demonstration of moderately to severely active disease by documented symptoms plus evidence of inflammation OR significant extent/upper GI involvement OR corticosteroid-dependence/refractory to oral corticosteroids.
For ulcerative colitis: removed required trial and failure of conventional therapy and replaced allowance for severely active disease with required demonstration of moderately to severely active disease by documented symptoms plus evidence of inflammation or high-risk disease OR corticosteroid-dependence/refractory to oral corticosteroids.
Allowed patients currently established on a biologic or systemic immunomodulator (not the requested agent) who have had positive clinical benefit to be eligible under criteria when other conditions are met.
Added HCPCS code J2267 and dosing / maximum unit references for IV induction dosing by indication (CD and UC).
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