Clinical Criteria updates for specialty pharmacy

The following Clinical Criteria documents were endorsed at the June 12, 2023, Clinical Criteria meeting. Visit our website to access the Clinical Criteria information.

New Clinical Criteria effective December 1, 2023

The following Clinical Criteria are new:

•    CC-0241 Elfabrio (pegunigalsidase alfa-iwxj)*

•    CC-0242 Epkinly (epcoritamab-bysp)*

•    CC-0243 Vyjuvek (beremagene geperpavec)*

Revised Clinical Criteria effective December 1, 2023

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-0015 Infertility and HCG Agents*

•    CC-0061 Gonadotropin Releasing Hormone Analogs for the Treatment of Non-Oncologic Indications*

•    CC-0062 Tumor Necrosis Factor Antagonists*

•    CC-0177 Zilretta (triamcinolone acetonide extended-release)*

* The applicable policy is attached to this article in PDF format.