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    v1.0.30
    OpenPayerPolicy UpdatesPharmacy & Specialty DrugsUPMC Health Plan Axatilimab Coverage | OpenPayer
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    CurrentUPMC Health PlanPolicy RX.PA.789

    Axatilimab (Niktimvo) Medicaid Coverage

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    This document appears to address Medicaid coverage and prior authorization for axatilimab (Niktimvo) under UPMC Health Plan. The available source content contains only document-interface text and does not expose the policy’s clinical criteria or coverage requirements.

    Policy Summary
    PayerUPMC Health Plan
    PolicyAxatilimab (Niktimvo) Medicaid Coverage
    Policy CodePolicy RX.PA.789
    Change TypeNo material change identified
    Effective DateN/A
    Next Review DateN/A
    Key ActionNo provider action is specified in the available source.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    Policy Summary
    PayerUPMC Health Plan
    PolicyAxatilimab (Niktimvo) Medicaid Coverage
    Policy CodePolicy RX.PA.789
    Change TypeNo material change identified
    Effective DateN/A
    Next Review DateN/A
    Key ActionNo provider action is specified in the available source.
    SourceLink

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