Omaveloxolone (Skyclarys)
Defines medical necessity criteria, initial and continued therapy requirements, dosing limits, required documentation, covered population (Friedreich's ataxia patients ≥16 years), exclusions for non‑FDA indications, and approval duration for Skyclarys across Centene lines of business.
Policy updated per FDA labeling to revise dosing and added requirement for LVEF ≥ 40%.
Removed requirement for maximal exercise testing on a recumbent stationary bike.
Modified baseline mFARS score requirement by removing prior 20–80 score range.
For genetic testing, specified that testing shows a GAA triplet‑repeat expansion in the FXN gene.
Removed exclusion for history of clinically significant left-sided heart disease and pes cavus, and removed requirement that member has ability to swallow capsules.
2Q 2024 annual review: no significant changes; references updated.
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.