Clinical Criteria updates for specialty pharmacy

The following Clinical Criteria documents were endorsed at the June 10, 2024, Clinical Criteria

meeting. Visit Clinical Criteria In Pharmacy to access the Clinical Criteria information.

New Clinical Criteria effective December 1, 2024

The following Clinical Criteria are new:

• CC-0264 Anktiva (nogapendekin alfa inbekicept-pmln)*

Revised Clinical Criteria effective December 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-0041 Complement C5 Inhibitors*
• CC-0166 Trastuzumab Agents*

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