CurrentCentenePolicy CP.PHAR.329

Siltuximab (Sylvant) (PDF)

Defines medical necessity, initial and continuation criteria, authorized indications (FDA-approved and NCCN-supported off-label uses), dosing limits, approval durations, contraindications, and coding guidance for siltuximab (Sylvant) for Centene-affiliated health plans (HIM, Medicaid).

Policy Summary

PayerCentene

PolicySiltuximab (Sylvant) (PDF)

Policy CodePolicy CP.PHAR.329

Change TypeMaterial updates and clarifications (CRS, KICS, duration, UCD language)

Effective DateMar 1, 2017

Next Review Date

Key ActionProvider must submit documentation (office notes, labs, biopsy results, HIV and HHV-8 test results, evidence of response, and supporting literature if off-label) to demonstrate member meets approval criteria.

SourceLink

POLICY UPDATE CHANGES

Added NCCN compendium supported use for CRS associated with CAR or autologous T cell therapy (1Q2022).

Extended initial approval duration from 6 to 12 months for maintenance medication for chronic condition (1Q2026).

Updated CRS criteria to allow Sylvant as replacement for second dose of Actemra/Tofidence/Tyenne/Avtozma per NCCN and added use in addition to tocilizumab for grade 2-4 CRS; removed replacement option for immunotherapy-related neurotoxicity (1Q2024-1Q2026 updates).

For off-label UCD, usage revised from 'relapsed or refractory' to 'surgically unresectable/or if incomplete resection' per NCCN.

3Covered Indications (explicit)

3Authorized Off-label Uses

11 mg/kg q3wStandard Dosing Limit

Up to 4CRS Dose Limit

Coverage Summary

Siltuximab (Sylvant) is covered with criteria for its FDA-approved indication for multicentric Castleman's disease (MCD) in HIV-negative and HHV-8-negative patients and for NCCN-supported off-label uses including cytokine release syndrome (CRS), Kaposi sarcoma–associated inflammatory cytokine syndrome (KICS), and surgically unresectable or incompletely resected unicentric Castleman's disease (UCD). Approval durations are 12 months for Castleman's disease (MCD/UCD) and KICS, and up to 4 doses total for CRS. The policy enforces a dosing limit of 11 mg/kg every 3 weeks unless a higher dose is supported by practice guidelines or peer-reviewed literature and documented by the prescriber.

Initial Approval Criteria

Provider must submit documentation supporting that member has met all approval criteria. Sylvant is medically necessary when the following criteria are met:

A. Castleman's Disease

Diagnosis of Castleman's disease (CD) confirmed by biopsy of involved tissue (usually a lymph node)
Prescribed by or in consultation with an oncologist
Age ≥ 18 years
Sylvant is prescribed in one of the following ways
- As single-agent therapy for multicentric Castleman's disease (MCD)
- As single-agent therapy for surgically unresectable or if incomplete resection unicentric Castleman's disease (UCD) (off-label)
Documented negative tests for HIV and HHV-8
Dose request meets one of the following
- Dose does not exceed 11 mg/kg every 3 weeks11 mg/kg q3w
- Dose is supported by practice guidelines or peer-reviewed literature for the relevant off-label use (prescriber must submit supporting evidence)
Prescribed regimen must be FDA-approved or recommended by NCCN

B. Cytokine Release Syndrome (CRS) (off-label)

Member has a scheduled CAR T cell therapy (examples: Kymriah, Yescarta, Abecma, Tecartus, Breyanzi, Carvykti, Avtozma)
Sylvant is prescribed in one of the following ways
- For management of grade 4 CRS that is refractory to high-dose corticosteroids and anti-IL-6 therapy
- As a replacement for the second dose of Actemra, Avtozma, Tofidence, or Tyenne when supplies are limited or unavailable for CRS
- In addition to tocilizumab, and one of the following
  - For grade 2 CRS, symptoms persist for > 24 hours
  - For grade 3-4 CRS, symptoms persist despite combination therapy with tocilizumab and corticosteroids

C. Kaposi-sarcoma associated herpesvirus (KSHV)-Associated Inflammatory Cytokine Syndrome (KICS) (off-label)

Diagnosis of refractory or progressive KICS
Prescribed by or in consultation with an oncologist
Sylvant is prescribed in addition to current Kaposi sarcoma-directed systemic therapies (e.g., doxorubicin with rituximab, paclitaxel, sirolimus)
Dose is within FDA maximum limit for any FDA-approved indication or supported by practice guidelines or peer-reviewed literature for the relevant off-label use (prescriber must submit supporting evidence)11 mg/kg q3w
Prescribed regimen must be FDA-approved or recommended by NCCN

Continuation (Reauthorization) Criteria

Continuation requests must meet the following:

A. Castleman's Disease (continuation)

Currently receiving medication via Centene benefit, or documentation supports member has received Sylvant for a covered indication for at least 30 days
Member is responding positively to therapy
If request is for a dose increase
- New dose does not exceed 11 mg/kg every 3 weeks11 mg/kg q3w
- New dose is supported by practice guidelines or peer-reviewed literature for the relevant off-label use (prescriber must submit supporting evidence)

Diagnoses/Indications Not Authorized

Coverage is not authorized for the following:

Non-FDA approved indications which are not addressed in this policy, unless sufficient documentation of efficacy and safety per off-label use policies or evidence of coverage documents is provided

Applicable Codes

HCPCS (Drug J-code)HCPCS

J2860

Injection, siltuximab, 10 mg

Provider Actions / Authorization Requirements

Prior Authorization

Prior authorization required

Requests are subject to Centene prior authorization per this clinical policy. Approval durations: 12 months for Castleman's disease (CD) and KICS; up to 4 doses total for CRS. Use HCPCS code J2860 for siltuximab billing.

Documentation Required

Submit supporting documentation

Provider must submit supporting documentation to demonstrate that the member meets approval criteria. Required documentation includes office chart notes, laboratory results, biopsy results, HIV and HHV-8 test results, evidence of response to therapy, and supporting peer-reviewed literature when requesting off-label dosing or use.

Office chart notes
Laboratory results
Biopsy results

Clinical Evidence

FDA Approval: Sylvant is indicated for MCD in HIV-negative and HHV-8-negative patients (Sylvant prescribing information cited, June 2024). NCCN Support: NCCN compendium and guidelines are used to support off-label indications such as CRS and KICS (references updated through 2026).

Background

Siltuximab is an interleukin-6 (IL-6) antagonist. The FDA indicates Sylvant for multicentric Castleman's disease (MCD) in patients who are HIV-negative and HHV-8-negative. This policy incorporates the FDA-approved indication and NCCN-supported off-label uses including CRS associated with CAR-T therapy and KICS.

Dose thresholds and definitions

Maximum Dose11 mg/kg every 3 weeks

CRS number of doses limit (initial/continuation)Up to 4 doses total

MCD (Multicentric Castleman's disease)Multicentric Castleman's disease

UCD (Unicentric Castleman's disease)Unicentric Castleman's disease

CRS (Cytokine Release Syndrome)Cytokine Release Syndrome

KICS (KSHV-associated inflammatory cytokine syndrome)

Revision History

1Q2022added

Added NCCN compendium-supported use for CRS associated with CAR or autologous T cell therapy; references reviewed and updated.

1Q2024-1Q2026revised

Updated CRS criteria to allow Sylvant as replacement for the second dose of Actemra or Tofidence (1Q2024) and later expanded replacement options (including Tyenne and Avtozma) and added use in addition to tocilizumab for grade 2-4 CRS; removed replacement option for immunotherapy-related neurotoxicity; added Carvykti as a CAR-T example.

1Q2026revisedLatest

Policy Summary

PayerCentene

PolicySiltuximab (Sylvant) (PDF)

Policy CodePolicy CP.PHAR.329

Change TypeMaterial updates and clarifications (CRS, KICS, duration, UCD language)

Effective DateMar 1, 2017

Next Review Date

SourceLink

On This Page

Dose is within FDA maximum limit for any FDA-approved indication or supported by practice guidelines or peer-reviewed literature for the relevant off-label use (prescriber must submit supporting evidence)11 mg/kg q3w

Prescribed regimen must be FDA-approved or recommended by NCCN

B. CRS (continuation)

Documentation supports member is currently receiving Sylvant for CAR T cell-induced CRS and member has not yet received 4 doses totalUp to 4 doses total
Member is responding positively to therapy
If request is for a dose increase, new dose is within FDA maximum limit for any FDA-approved indication or is supported by practice guidelines or peer-reviewed literature (prescriber must submit supporting evidence)11 mg/kg q3w
Prescribed regimen must be FDA-approved or recommended by NCCN

C. KICS (continuation)

Currently receiving medication via Centene benefit, or documentation supports that member has received Sylvant for a covered indication for at least 30 days
Member is responding positively to therapy
Documentation supports member is currently receiving Sylvant in addition to current Kaposi sarcoma-directed systemic therapies
If request is for a dose increase, new dose is within FDA maximum limit for any FDA-approved indication or is supported by practice guidelines or peer-reviewed literature (prescriber must submit supporting evidence)11 mg/kg q3w
Prescribed regimen must be FDA-approved or recommended by NCCN

D. Other diagnoses/indications (continuation)

If drug label changed within last 6 months not yet reflected in policy, refer to formulary/no coverage/non-formulary policies as directed (HIM.PA.33; CP.PMN.255; HIM.PA.103; CP.PMN.16)
If requested use is not specifically listed under section III and above does not apply, refer to off-label use policies (HIM.PA.154; CP.PMN.53)

HIV and HHV-8 test results

Evidence of clinical response

Supporting peer-reviewed literature for off-label use/dosing

Billing Rule

Dose limit enforcement

Claims should not exceed dosing of 11 mg/kg every 3 weeks unless the dose is supported by practice guidelines or peer-reviewed literature and documented. For CRS, approval is limited to up to 4 total doses. Use HCPCS code J2860 for siltuximab (10 mg unit).

Standard dosing limit: 11 mg/kg IV every 3 weeks
CRS dosing limit: up to 4 total doses
Dose increases must be supported by guidelines or peer-reviewed literature

Documentation Required

Oncologist involvement required

Sylvant must be prescribed by or in consultation with an oncologist for Castleman's disease (CD) and KICS; documentation of the oncologist prescription or consultation must be provided with the request.

KSHV-associated inflammatory cytokine syndrome

Extended initial approval duration from 6 to 12 months for maintenance therapy; clarified off-label UCD usage to 'surgically unresectable/or if incomplete resection'; added KICS as an off-label indication per NCCN; approval durations and CRS dose limits specified (up to 4 doses).

clarified

For off-label UCD, usage revised from 'relapsed or refractory' to 'surgically unresectable/or if incomplete resection' per NCCN; template changes applied.

added

References reviewed and updated; product described as an IL-6 antagonist indicated for MCD in HIV-negative and HHV-8-negative patients; dosing limit set at 11 mg/kg every 3 weeks.