CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Arikayce (amikacin liposome inhalation suspension) coverage for Mycobacterium avium complex (MAC) lung disease

Defines coverage criteria for Arikayce (amikacin liposome inhalation suspension) for adults with refractory MAC lung disease for members of Neighborhood Health Plan of Rhode Island (Medicaid), including initiation and continuation/reauthorization requirements.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyArikayce (amikacin liposome inhalation suspension) coverage for Mycobacterium avium complex (MAC) lung disease

Policy CodePolicy N/A

Change TypeNo material change

Effective DateApr 15, 2019

Next Review DateN/A

Key ActionObtain prior authorization and document ≥6 months of prior multidrug background therapy, lack of negative sputum cultures, and plan for combination antibacterial therapy; for reauthorization provide evidence of benefit such as disease stability or negative sputum cultures.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12authorization period (initial and continuation)

>=6minimum prior multidrug background regimen duration

adultsage group covered (per FDA indication)

Coverage Criteria for Arikayce (amikacin liposome inhalation suspension)

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