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Medical Mutual of Ohio Medical Policy Updates – June 2018
Click here to view the Medical Mutual of Ohio Medical Policy Updates »
June 2018 Medical Policy Updates:
- Crysvita® (burosumab-twza) Ryplazim™ (plasminogen)
- Investigational Experimental Services Not Eligible for Reimbursement
- Kevzara (sarilumab)
- Kymriah (tisagenlecleucel) suspension for IV infusion
- Leuprolide long-acting
- Oncology Medications
- Repository Corticotropin Injection (H.P. Acthar® Gel)
- Siliq (brodalumab)
- Soliris® (Eculizumab)
- Yervoy (ipilimumab)
Added 6/27/2018;
- Auditory Brainstem Implantation
- Bavencio (avelumab)
- Calcitonin Gene-Related Peptide (CGRP) Antagonist
- Continuous Glucose Monitoring and Continuous Glucose Monitoring Systems
- Crysvita (burosumab-twza injection for subcutaneous use – Ultragenyx)
- Crysvita® (burosumab-twza) Ryplazim™ (plasminogen)
- Doxil (doxorubicin hydrochloride injection for intravenous use)
- Doxorubicin hydrochloride lyophilized powder for intravenous use
- Erythropoiesis Stimulating Agents
- Fasenra (benralizumab)
- Genetic Testing and Genetic Counseling General
- Growth Stimulating Drugs
- Hemlibra (emicizumab-kxwh injection)
- Hyaluronic acid derivatives, intraarticular
- Imfinzi (durvalumab)
- Investigational Experimental Services Not Eligible for Reimbursement
- iStent Trabecular Micro-Bypass
- Lutathera (lutetium Lu 177 dotatate injection for intravenous [IV] use)
- Luxturna (Voretigene Neparvovec-rzyl)
- Not Medically Necessary Services
- Nplate (romiplostim for subcutaneous injection)
- Oncology Medications
- Palynziq (pegvaliase-pqpz)
- Perjeta (pertuzumab injection, for intravenous [IV] use)
- Recombinant Human Bone Morphogenetic Protein-2
- Repository Corticotropin Injection (H.P. Acthar® Gel)
- Rituxan Hycela (rituximab and hyaluronidase human injection for subcutaneous use )
- Transcatheter Pulmonary Valve Implantation
- Tremfya (guselkumab for SC injection)
- Zilretta (triamcinolone acetonide extended-release injectable suspension)
Click here to view the Medical Mutual of Ohio Medical Policy Updates »
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