Pretomanid (for drug-resistant pulmonary tuberculosis)
Defines Centene clinical policy for medical necessity, initial and continuation approval criteria, dosing, limitations, contraindications, and administrative requirements for pretomanid as part of the BPaL regimen (bedaquiline, pretomanid, linezolid) for treatment of specified drug-resistant pulmonary tuberculosis across Commercial, HIM, and Medicaid lines of business.
Lowered age requirement from 17 to 15 years per updated WHO 2022 guidance and clarified approval duration as 26 weeks.
Updated linezolid dosing from 1,200 mg to 600 mg per updated CDC recommendations.
Clarified expert in treatment of tuberculosis to include public health departments, CDC-designated Centers of Excellence specialists, and ID specialists managing TB clinics.
Updated approved indication language to align with prescribing information and removed references to multidrug-resistant and extensively drug-resistant TB terminology.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.