Cenegermin-bkbj (Oxervate)
Defines medical necessity criteria, initial and continued therapy criteria, dosing limits, covered diagnosis (neurotrophic keratitis stage 2 or 3), approval durations, prescriber requirements, and references for Oxervate for Centene-affiliated lines of business (Commercial, HIM, Medicaid).
1Q 2023 annual review added criteria clarifying maximum treatment duration: Member has not received ≥ 16 weeks total of Oxervate treatment per affected eye(s) and continued therapy approval limited to lifetime 2 courses per affected eye.
1Q 2024 annual review added optometrist as an additional prescriber option.
IQ 2025 annual review: no significant changes; references reviewed and updated.