Adakveo (crizanlizumab) medical benefit
Defines medical benefit coverage, initial and continuation criteria, quantity limits, authorization periods, and applicable billing code for crizanlizumab (Adakveo) for treatment of sickle cell disease in members aged 16 and older.
No material clinical or coverage changes in this update.
Coverage Summary
Medical benefit coverage for crizanlizumab (Adakveo) to prevent vaso-occlusive crises in patients with sickle cell disease aged ≥16; coverage stance: covered_with_criteria. Specialist-prescribing expectations and prior therapy requirements (or provision of a named Sickle Cell Center of Excellence when that path is used) are defined in the criteria and required for authorization.
Initial Therapy Criteria
Continuation of Therapy Criteria
Continuation of Therapy
Covered when ALL of the following are met:
ALL of the following
- Prescribed by a hematologist
- Diagnosis of sickle cell disease
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