Clinical Criteria updates for specialty pharmacy

The following Clinical Criteria documents were endorsed at the December 11, 2023, Clinical Criteria meeting. Visit our website to access the Clinical Criteria information.

New Clinical Criteria effective June 1, 2024

The following Clinical Criteria are new:

• CC-0255 Loqtorzi (toripalimab-tpzi)
• CC-0256 Rivfloza (nedosiran)

Revised Clinical Criteria effective June 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-0002 Colony Stimulating Factor Agents
• CC-0107 Bevacizumab for Non-ophthalmologic Indications
• CC-0110 Perjeta (pertuzumab)
• CC-0185 Oxlumo (lumasiran)