Isavuconazonium (Cresemba) Clinical Policy
Clinical coverage and coding guidance for isavuconazonium (Cresemba) including product formulations, coding implications, and references; applies to providers submitting coverage requests to the Health Plan.
No material clinical or coverage changes in this revision.
Coverage Criteria
Policy history documents incremental updates to coding and utilization controls for isavuconazonium. Notable revisions include the addition of HCPCS code J1833 to the policy's coding listing during the 2Q 2024 review, clarification of pediatric applicability for voriconazole trial requirements, and an operational clarification in 2Q 2025 about injection requests for nasogastric tube administration versus capsules. The policy also incorporates a jurisdiction-specific step therapy bypass for Illinois HIM per IL HB 5395.
Per the Specialty Drug Committee (SDC) action dated 10.08.25, the policy redirects treatment for mucormycosis and aspergillosis in members aged ≥ 13 years to posaconazole when the member has had a prior inadequate response (defined as refractory or progressive disease) to voriconazole. Providers should confirm plan-specific prior authorization rules and operational impact, as code inclusion does not guarantee coverage.
Coding
| J1833 | Injection, isavuconazonium, 1 mg |
Provider Actions and Billing Notes
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