Enspryng (satralizumab-mwge) subcutaneous injection — Coverage Criteria for NMOSD
This Cigna coverage policy governs prior authorization and medical necessity criteria for Enspryng (satralizumab-mwge) subcutaneous injection for treatment of adults with anti-aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (NMOSD). It applies to benefits administered by Cigna Companies.
Added criteria for 'Patient is Currently Receiving Enspryng'.
Added Ultomiris (ravulizumab-cwvz) to the list of agents not allowed concomitantly with Enspryng.
Added requirement that diagnosis be confirmed by positive anti-aquaporin-4 antibody blood serum test with documentation required.
Title updated from satralizumab-mwge to Enspryng.
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