New specialty pharmacy medical injectable step therapy requirements

Effective for dates of service on and after June 1, 2020, the following medical injectable drugs and corresponding codes will be included in our medical step therapy precertification review process. Step therapy review will apply upon precertification initiation or renewal in addition to other current medical necessity review of all drugs noted below. Haegarda® and Takhzyro™ will be the preferred prophylactic agents over Cinryze®. 

 

The Clinical Criteria below will be updated to include the required trial of the preferred drug:

 

Clinical Criteria	Preferred drug	Nonpreferred drug
ING-CC-0034	Haegarda (J0599)	Cinryze (J0598)
ING-CC-0034	Takhzyro (J3490, J3590, C9399)	Cinryze (J0598)

Clinical Criteria is made publicly available on our provider website. Visit the Clinical Criteria website to search for specific Clinical Criteria.

 

 For questions or additional information, use this email.