Clinical Criteria updates for specialty pharmacy

The following Clinical Criteria documents were endorsed at the September 27, 2023, Clinical Criteria meeting. Visit our website to access the Clinical Criteria information.

New Clinical Criteria effective March 1, 2024

The following Clinical Criteria are new:

• CC-0250 Veopoz (pozelimab-bbfg)
• CC-0251 Ycanth (cantharidin)

Revised Clinical Criteria effective March 1, 2024

The following Clinical Criteria were revised and might result in services that were previously covered but may now be found to be not medically necessary:

• CC-0018 Pompe Disease [Lumizyme (alglucosidase alfa), Nexviazyme (avalglucosidase alfa-ngpt), Pombiliti (cipaglucosidase alfa-atga)]
• CC-0020 Natalizumab Agents (Tysabri, Tyruko)
• CC-0021 Fabrazyme (agalsidase beta)
• CC-0046 Zinplava (bezlotoxumab)
• CC-0068 Growth Hormones
• CC-0233 Rebyota (fecal microbiota, live — jslm)