Ryoncil (remestemcel-L) for steroid-refractory acute graft-versus-host disease (SR-aGVHD) in pediatric patients
Policy governs prior authorization, coverage criteria, dosing limits, renewal criteria, and billing guidance for Ryoncil (remestemcel-L) for Medicaid, Commercial, and MMP members of Neighborhood Health Plan of Rhode Island; applies to pediatric patients aged 2 months to 17 years with steroid-refractory aGVHD.
No material clinical or coverage changes
Coverage Summary
Policy governs prior authorization, coverage criteria, dosing limits, renewal criteria, and billing guidance for Ryoncil (remestemcel-L) for Medicaid, Commercial, and MMP members. Coverage stance: covered_with_criteria. The subject is Ryoncil (remestemcel-L-rknd) for steroid-refractory acute graft-versus-host disease (SR-aGVHD) in pediatric patients. The policy applies to pediatric patients aged >= 2 months and <= 17 years with steroid-refractory aGVHD and specifies requirements for prior authorization, specialist prescribing, age limits, and dosing/authorization limits.
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