Sylvant
This policy defines coverage criteria, laboratory thresholds, dosing rounding, continuation criteria, quantity limits, authorization period, and applicable billing code for siltuximab (Sylvant) when used to treat multicentric Castleman disease (MCD)/iMCD.
Document includes dose rounding requirement and necessity for clinical rationale if eligible dose is not rounded down.
Coverage Summary
Coverage for siltuximab (Sylvant) is covered with criteria for treatment of multicentric Castleman disease (MCD). The policy requires that the drug be prescribed by or in consultation with a hematologist or oncologist and that the diagnosis meet CDCN diagnostic criteria (lymph node biopsy characteristic of MCD, enlarged lymph nodes in ≥ 2 stations on CT/PET, and at least 2 minor CDCN criteria including ≥1 laboratory criterion). Prior to the first dose the policy requires laboratory thresholds including ANC ≥ 1.0 x 10^9/L, platelets ≥ 75 x 10^9/L, and hemoglobin < 17 g/dL. Dose rounding to the nearest vial is required when within 10% of a vial and specialist involvement and documented labs are required for approval.
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