CurrentColorado Rocky Mountain Health PlansPolicy IEXD0091.10

Uplizna (inebilizumab-cdon) Medical Benefit Drug Policy

Defines UnitedHealthcare Individual Exchange medical benefit coverage criteria for Uplizna (inebilizumab-cdon) for NMOSD, IgG4-related disease, and generalized myasthenia gravis (gMG); applies to Individual Exchange plans in all states except Nevada.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyUplizna (inebilizumab-cdon) Medical Benefit Drug Policy

Policy CodePolicy IEXD0091.10

Change TypeRevised and added coverage criteriaupdated applicable codes and states

Effective DateApr 1, 2026

Next Review Date

Key ActionSubmit prior authorization with required documentation (diagnosis confirmation, serology/ACR‑EULAR assessment, MGFA/MG-ADL scores, prior therapy history) for initial and continuation requests, limited to a maximum of 12 months.

SourceLink

POLICY UPDATE CHANGES

Revised NMOSD coverage criteria by removing requirement for prior relapses (one in 12 months or two in 24 months) prior to initiating Uplizna.

Added coverage criteria for generalized myasthenia gravis (gMG) for AChR- or MuSK-antibody positive patients.

Added ICD-10 diagnosis codes G70.00 and G70.01 to Applicable Codes.

Applicable states updated: policy applies to Individual Exchange plans in all states except Nevada; prior exclusions for Massachusetts and New York were removed.

3Indications with coverage criteria (NMOSD, IgG4-RD, gMG)

12Maximum initial and reauthorization approval period (months)

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.