Pa Med Nec Skyclarys
Defines prior authorization/medical necessity criteria for Skyclarys (omaveloxolone) for treatment of Friedreich's ataxia in adults and adolescents (≥16 years), including initial authorization, reauthorization, prescriber requirements, authorization duration, and additional clinical rules.
Annual reviews in 5/2024 and 5/2025 noted no updates to coverage criteria and updated references.
Effective date set to 8/1/2025 for the program.
Coverage Summary
Defines prior authorization/medical necessity criteria for Skyclarys (omaveloxolone) for treatment of Friedreich's ataxia in adults and adolescents ≥16 years, specifying initial authorization and reauthorization requirements, prescriber specialties, and a 12-month authorization duration under the payer's clinical pharmacy program.